title: Efficacy and Safety of Propofol-Mediated Sedation for Outpatient Endoscopic Retrograde Cholangiopancreatography (ERCP).
abstract: Propofol sedation for endoscopy may result in a rapid and unpredictable progression from deep sedation to general anesthesia, leading to potential complications. We investigated the incidence and predictors of sedation-related adverse events (SAEs) in nonintubated patients who underwent outpatient ERCP procedures with propofol sedation.
  
  
  
  We conducted a retrospective study of patients who underwent propofol sedation for ERCP procedures. Patients were sedated using propofol in combination with low-dose opiates. Data collected included patient demographics, American Society of Anesthesiologists (ASAs) physical status, and procedure times. SAE includes hypoxia (pulse oximetry <90 %), hypotension (systolic blood pressure <90 mmHg), and conversation to endotracheal intubation. Factors associated with SAEs were examined by univariate analysis and multivariate regression analysis (MVA).
  
  
  
  A total of 3041 patients were evaluated. The median BMI was 25.2 kg/m(2), and the median ASA score was 3. The mean (±SD) duration of the procedures was 59 ± 23 min. Hypoxia requiring airway manipulation occurred in 28 % (n = 843) patients and hypotension requiring vasopressors in 0.4 % (n = 12). Forty-nine (1.6 %) patients required endotracheal intubation as a result of food in the stomach. Procedures underwent early termination in 8 (0.3 %) cases due to sedation-related hypotension (n = 5) and refractory laryngospasm (n = 3). Six patients were admitted after the ERCP for aspiration pneumonia as a result of sedation. Patients who developed SAE were older, had a higher mean BMI, and had longer mean procedure durations. On MVA, older age (p = 0.003), female sex (p = 0.001), BMI (p = 0.02), and ASA class ≥3 (p = 0.01) independently predicted SAEs.
  
  
  
  Propofol can be used safely and effectively as a sedative agent for patients undergoing ERCPs when administered by trained professionals. Age, female sex, BMI, and ASA class ≥3 are independent predictors of SAEs.
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Juliana F
authors.initials: JF
authors.lastname: Yang
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, 19107, USA.
authors.forename: Priya
authors.initials: P
authors.lastname: Farooq
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, 19107, USA.
authors.forename: Kate
authors.initials: K
authors.lastname: Zwilling
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, 19107, USA.
authors.forename: Devi
authors.initials: D
authors.lastname: Patel
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, 19107, USA. Ali.Siddiqui@Jefferson.edu.
authors.forename: Ali A
authors.initials: AA
authors.lastname: Siddiqui
mesh_terms: D002760:Cholangiopancreatography, Endoscopic Retrograde; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000009:adverse effects* / Q000494:pharmacology; D010045:Outpatients; D015742:Propofol / Q000008:administration & dosage / Q000009:adverse effects* / Q000494:pharmacology; D012189:Retrospective Studies
chemical_list: D006993:Hypnotics and Sedatives; D015742:Propofol
keywords: Adverse events; Endoscopic retrograde cholangiopancreatography; Propofol
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