Conscious sedation for upper endoscopy in the gastric bypass patient: prevalence of cardiopulmonary adverse events and predictors of sedation requirement.
BACKGROUND
Safety of conscious sedation for performing esophagoduodenoscopy (EGD) in obese and Roux-en-Y gastric bypass (RYGB) patients remains controversial. Additionally, it has been suggested that patients with higher body mass index (BMI) require higher sedation doses, imparting greater risk.


OBJECTIVE
The aim of this study is to assess the prevalence of sedation-related adverse events and the independent predictors of sedation requirements in RYGB patients.


METHODS
This study is a retrospective database review of RYGB patients who underwent EGD under conscious sedation. Database analysis was performed and linear regression applied to identify significant predictors of sedation requirement. Primary outcomes are sedation-related adverse events and predictors of sedation requirement.


RESULTS
Data on 1,385 consecutive procedures (diagnostic 967; therapeutic 418) performed under conscious sedation were analyzed. Unplanned events were reported in 1.6 %, with 0.6 % being cardiopulmonary in nature and 0.7 % requiring early termination. Multivariable linear regression revealed procedural time was the only significant predictor of fentanyl (standardized β 0.34; P value < 0.001) and midazolam (standardized β 0.30; P value < 0.001) doses. Post-RYGB BMI was not significantly associated with the dose of fentanyl (standardized β 0.08; P value 0.29) or midazolam administered (standardized β 0.01; P value 0.88).


CONCLUSIONS
Upper endoscopy can be safely performed in RYGB patients under conscious sedation with a similar cardiopulmonary risk profile to that of standard EGD. The non-cardiopulmonary adverse events were procedure-specific and unrelated to sedation. Procedure length, and not absolute BMI, was the only predictor of sedation requirement in this patient population.
Yale New Haven Hospital, New Haven, CT, USA.
Pichamol
P
Jirapinyo
Barham K
BK
Abu Dayyeh
Christopher C
CC
Thompson
D000328:Adult; D018686:Anesthetics, Intravenous / Q000008:administration & dosage / Q000009:adverse effects*; D001145:Arrhythmias, Cardiac / Q000139:chemically induced; D015992:Body Mass Index; D016292:Procedural Sedation / Q000009:adverse effects*; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects*; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage / Q000009:adverse effects*; D015390:Gastric Bypass; D006801:Humans; D007022:Hypotension / Q000139:chemically induced; D000860:Hypoxia / Q000139:chemically induced; D008297:Male; D008874:Midazolam / Q000008:administration & dosage / Q000009:adverse effects*; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000601:surgery; D061646:Operative Time; D012189:Retrospective Studies; D012307:Risk Factors
D018686:Anesthetics, Intravenous; D008874:Midazolam; D005283:Fentanyl