title: Difficult colonoscopies in the propofol era.
abstract: BACKGROUND
  To study the relationship between endoscopic practice and adverse events during colonoscopy under standard deep sedation induced and monitored by an anesthetist.
  
  
  METHODS
  We investigated the routine activity of an endoscopy center at the Padova University teaching hospital. We considered not only endoscopic and cardiorespiratory complications, but also the need to use high-dose propofol to complete the procedure, and the inability to complete the procedure. Variables relating to the patient's clinical conditions, bowel preparation, the endoscopist's and the anesthetist's experience, and the duration of the procedure were input in the model.
  
  
  RESULTS
  617 procedures under deep sedation were performed with a 5% rate of adverse events. The average dose of propofol used was 2.6 ± 1.2 mg/kg. In all, 14 endoscopists and 42 anesthetists were involved in the procedures. The logistic regression analysis identified female gender (OR=2.3), having the colonoscopy performed by a less experienced endoscopist (OR=1.9), inadequate bowel preparation (OR=3.2) and a procedure lasting longer than 17.5 minutes (OR=1.6) as the main risk factors for complications. An ASA score of 2 carried a 50% risk reduction (OR=0.5).
  
  
  CONCLUSIONS
  Our model showed that none of the variables relating to anesthesiological issues influenced which procedures would prove difficult.
authors.affiliation: Department of Surgical and Gastroenterological Sciences, Padova University Hospital, Italy, Via Giustiniani n2, 35126 Padova, Italy. fabrizio.cardin@sanita.padova.it
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Cardin
authors.forename: Nadia
authors.initials: N
authors.lastname: Minicuci
authors.forename: Federico
authors.initials: F
authors.lastname: Campigotto
authors.forename: Alessandra
authors.initials: A
authors.lastname: Andreotti
authors.forename: Elisa
authors.initials: E
authors.lastname: Granziaera
authors.forename: Barbara
authors.initials: B
authors.lastname: Donà
authors.forename: Bruno
authors.initials: B
authors.lastname: Martella
authors.forename: Claudio
authors.initials: C
authors.lastname: Terranova
authors.forename: Carmelo
authors.initials: C
authors.lastname: Militello
mesh_terms: D000368:Aged; D002983:Clinical Competence; D003113:Colonoscopy / Q000009:adverse effects / Q000379:methods; D054810:Deep Sedation / Q000009:adverse effects; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000009:adverse effects; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010043:Outcome and Process Assessment, Health Care; D015742:Propofol / Q000008:administration & dosage / Q000009:adverse effects; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors
chemical_list: D006993:Hypnotics and Sedatives; D015742:Propofol