title: Risk Factors and Outcomes of Reversal Agent Use in Moderate Sedation During Endoscopy and Colonoscopy.
abstract: BACKGROUND
  Moderate sedation has been standard for noninvasive gastrointestinal procedures for decades yet there are limited data on reversal agent use and outcomes associated with need for reversal of sedation.
  
  
  OBJECTIVE
  To determine prevalence and clinical significance of reversal agent use during endoscopies and colonoscopies.
  
  
  METHODS
  Individuals with adverse events requiring naloxone and/or flumazenil during endoscopy or colonoscopy from 2008 to 2013 were identified. A control group was obtained by random selection of patients matched by procedure type and date. Prevalence of reversal agent use and statistical comparison of patient demographics and risk factors against controls were determined.
  
  
  RESULTS
  Prevalence of reversal agent use was 0.03% [95% confidence interval (CI), 0.02-0.04]. Events triggering reversal use were oxygen desaturation (64.4%), respiration changes (24.4%), hypotension (8.9%), and bradycardia (6.7%). Two patients required escalation of care and the majority of patients were stabilized and discharged home. Compared with the control group, the reversal group was older (61±1.8 vs. 55±1.6, P=0.01), mostly female (82% vs. 50%, P<0.01), and had lower body mass index (24±0.8 vs. 27±0.7, P=0.03) but received similar dosages of sedation. When adjusted for age, race, sex, and body mass index, the odds of reversal agent patients having a higher ASA score than controls was 4.7 (95% CI, 1.7-13.1), and the odds of having a higher Mallampati score than controls was 5.0 (95% CI, 2.1-11.7) with P<0.01.
  
  
  CONCLUSIONS
  Prevalence of reversal agent use during moderate sedation is low and outcomes are generally good. Several clinically relevant risk factors for reversal agent use were found suggesting that certain groups may benefit from closer monitoring.
authors.affiliation: Departments of *Gastroenterology ‡Anesthesiology †Division of Pharmacy, Beth Israel Deaconess Medical Center (BIDMC), Boston, MA.
authors.forename: Adelina
authors.initials: A
authors.lastname: Hung
authors.forename: John
authors.initials: J
authors.lastname: Marshall
authors.forename: Sheila
authors.initials: S
authors.lastname: Barnett
authors.forename: Zalman M
authors.initials: ZM
authors.lastname: Falchuk
authors.forename: Mandeep
authors.initials: M
authors.lastname: Sawhney
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Leffler
mesh_terms: D000367:Age Factors; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage; D000931:Antidotes / Q000008:administration & dosage*; D001285:Atropine / Q000008:administration & dosage; D015992:Body Mass Index; D001919:Bradycardia / Q000139:chemically induced / Q000188:drug therapy; D016022:Case-Control Studies; D003113:Colonoscopy / Q000009:adverse effects; D016292:Procedural Sedation / Q000009:adverse effects*; D005260:Female; D005283:Fentanyl / Q000009:adverse effects / Q000037:antagonists & inhibitors; D005442:Flumazenil / Q000008:administration & dosage; D006304:Health Status; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects / Q000037:antagonists & inhibitors*; D007022:Hypotension / Q000139:chemically induced / Q000188:drug therapy; D000860:Hypoxia / Q000139:chemically induced / Q000188:drug therapy; D008297:Male; D008874:Midazolam / Q000009:adverse effects / Q000037:antagonists & inhibitors; D008875:Middle Aged; D009270:Naloxone / Q000008:administration & dosage; D009292:Narcotic Antagonists / Q000008:administration & dosage*; D012737:Sex Factors; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents; D000931:Antidotes; D006993:Hypnotics and Sedatives; D009292:Narcotic Antagonists; D009270:Naloxone; D005442:Flumazenil; D001285:Atropine; D008874:Midazolam; D005283:Fentanyl