title: Cardiac arrests in patients undergoing gastrointestinal endoscopy: A retrospective analysis of 73,029 procedures.
abstract: OBJECTIVE
  Airway difficulties leading to cardiac arrest are frequently encountered during propofol sedation in patients undergoing gastrointestinal (GI) endoscopy. With a noticeable increase in the use of propofol for endoscopic sedation, we decided to examine the incidence and outcome of cardiac arrests in patients undergoing gastrointestinal (GI) endoscopy with sedation.
  
  
  METHODS
  In this retrospective study, cardiac arrest data obtained from the clinical quality improvement and local registry over 5 years was analyzed. The information of patients who sustained cardiac arrest attributable to sedation was studied in detail. Analysis included comparison of cardiac arrests due to all causes until discharge (or death) versus the cardiac arrests and death occurring during the procedure and in the recovery area.
  
  
  RESULTS
  The incidence of cardiac arrest and death (all causes, until discharge) was 6.07 and 4.28 per 10,000 in patients sedated with propofol, compared with non-propofol-based sedation (0.67 and 0.44). The incidence of cardiac arrest during and immediately after the procedure (recovery area) for all endoscopies was 3.92 per 10,000; of which, 72% were airway management related. About 90.0% of all peri-procedural cardiac arrests occurred in patients who received propofol.
  
  
  CONCLUSIONS
  The incidence of cardiac arrest and death is about 10 times higher in patients receiving propofol-based sedation compared with those receiving midazolam-fentanyl sedation. More than two thirds of these events occur during EGD and ERCP.
authors.affiliation: Department of Clinical Anesthesiology and Critical Care, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA.
authors.forename: Basavana
authors.initials: B
authors.lastname: Goudra
authors.forename: Ahmad
authors.initials: A
authors.lastname: Nuzat
authors.forename: Preet M
authors.initials: PM
authors.lastname: Singh
authors.forename: Gowri B
authors.initials: GB
authors.lastname: Gouda
authors.forename: Augustus
authors.initials: A
authors.lastname: Carlin
authors.forename: Amit K
authors.initials: AK
authors.lastname: Manjunath
mesh_terms: D000328:Adult; D000368:Aged; D018686:Anesthetics, Intravenous / Q000008:administration & dosage / Q000009:adverse effects; D016292:Procedural Sedation / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage; D006323:Heart Arrest / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D015994:Incidence; D008297:Male; D008874:Midazolam / Q000008:administration & dosage; D008875:Middle Aged; D010414:Pennsylvania / Q000453:epidemiology; D015742:Propofol / Q000009:adverse effects; D012189:Retrospective Studies
chemical_list: D018686:Anesthetics, Intravenous; D008874:Midazolam; D005283:Fentanyl; D015742:Propofol