title: Sedation-associated complications in endoscopy are not reduced significantly by implementation of the German S-3-guideline and occur in a severe manner only in patients with ASA class III and higher.
abstract: BACKGROUND
  The German guideline for sedation in gastrointestinal endoscopy was published in 2008. Several recommendations in this guideline, especially concerning staffing and structural requirements for sedation, have low evidence and therefore are subject to discussion in the field.
  
  
  OBJECTIVE
  Comparison of endoscopic complications in a department specialized for gastrointestinal and pulmological diseases before and after implementation of the German guideline grouped in sedation-associated and non-sedation-associated complications.
  
  
  METHODS
  Prospective documentation of complications with retrospective analysis of two patient groups (before guideline: 1.5.2008-30.4.2010; after guideline: 1.5.2010-30.4.2012) at which the sedation technique remained the same (balanced propofol sedation, BPS).
  
  
  RESULTS
  Both investigation periods covered almost 7000 procedures. Interventional and general complications were nonsignificantly elevated in the latter group (1.27% before vs. 1.55% after guideline, p = 0.08). Saturation decline (in both groups 0.26%) was unchanged, and circulation-associated complications (0.27% vs. 0.13%, p = 0.07) were reduced nonsignificantly. Necessity for the administration of flumazenil and for intensive care monitoring was reduced in a nonsignificant manner after the implementation of the guideline. Severe complications (reanimation, apnea, and death) were unchanged, and no patient with ASA I-II suffered from a severe complication. Propofol consumption was higher after guideline implementation.
  
  
  CONCLUSIONS
  The recommendations of the new German sedation guideline do not significantly reduce complications in endoscopic procedures. Especially, procedures involving patients with ASA classes I and II do not require an additional staff member solely for sedation. Prospective randomized studies might be necessary to optimize the utilization of resources.
authors.affiliation: Medical Clinic, Bethlehem-Hospital, Academic Affiliated Hospital of the Technical University Aachen, Stolberg/Rhld, Germany. dietrich@bethlehem.de
authors.forename: Christoph G
authors.initials: CG
authors.lastname: Dietrich
authors.forename: Tanja
authors.initials: T
authors.lastname: Kottmann
authors.forename: Angela
authors.initials: A
authors.lastname: Diedrich
authors.forename: Frank M
authors.initials: FM
authors.lastname: Drouven
mesh_terms: D000931:Antidotes / Q000627:therapeutic use; D001049:Apnea / Q000209:etiology; D003422:Critical Care / Q000706:statistics & numerical data; D054810:Deep Sedation / Q000009:adverse effects* / Q000401:mortality / Q000592:standards*; D003695:Delivery of Health Care / Q000458:organization & administration; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects* / Q000592:standards*; D005442:Flumazenil / Q000627:therapeutic use; D005858:Germany; D017408:Guidelines as Topic; D006304:Health Status; D006801:Humans; D006993:Hypnotics and Sedatives; D010561:Personnel Staffing and Scheduling; D015742:Propofol; D012189:Retrospective Studies
chemical_list: D000931:Antidotes; D006993:Hypnotics and Sedatives; D005442:Flumazenil; D015742:Propofol