title: Patient safety during sedation by anesthesia professionals during routine upper endoscopy and colonoscopy: an analysis of 1.38 million procedures.
abstract: OBJECTIVE
  Sedation for GI endoscopy directed by anesthesia professionals (ADS) is used with the intention of improving throughput and patient satisfaction. However, data on its safety are sparse because of the lack of adequately powered, randomized controlled trials comparing it with endoscopist-directed sedation (EDS). This study was intended to determine whether ADS provides a safety advantage when compared with EDS for EGD and colonoscopy.
  
  
  METHODS
  This retrospective, nonrandomized, observational cohort study used the Clinical Outcomes Research Initiative National Endoscopic Database, a network of 84 sites in the United States composed of academic, community, health maintenance organization, military, and Veterans Affairs practices. Serious adverse events (SAEs) were defined as any event requiring administration of cardiopulmonary resuscitation, hospital or emergency department admission, administration of rescue/reversal medication, emergency surgery, procedure termination because of an adverse event, intraprocedural adverse events requiring intervention, or blood transfusion.
  
  
  RESULTS
  There were 1,388,235 patients in this study that included 880,182 colonoscopy procedures (21% ADS) and 508,053 EGD procedures (23% ADS) between 2002 and 2013. When compared with EDS, the propensity-adjusted SAE risk for patients receiving ADS was similar for colonoscopy (OR, .93; 95% CI, .82-1.06) but higher for EGD (OR, 1.33; 95% CI, 1.18-1.50). Additionally, with further stratification by American Society of Anesthesiologists (ASA) class, the use of ADS was associated with a higher SAE risk for ASA I/II and ASA III subjects undergoing EGD and showed no difference for either group undergoing colonoscopy. The sample size was not sufficient to make a conclusion regarding ASA IV/V patients.
  
  
  CONCLUSIONS
  Within the confines of the SAE definitions used, use of anesthesia professionals does not appear to bring a safety benefit to patients receiving colonoscopy and is associated with an increased SAE risk for ASA I, II, and III patients undergoing EGD.
authors.affiliation: Department of Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: John J
authors.initials: JJ
authors.lastname: Vargo
authors.affiliation: Ethicon Endo-Surgery Inc., Cincinnati, Ohio, USA; Department of Pharmacology and Cell Biophysics, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Niklewski
authors.affiliation: Division of Gastroenterology, Oregon Health and Science University, Portland, Oregon, USA.
authors.forename: J Lucas
authors.initials: JL
authors.lastname: Williams
authors.affiliation: Ethicon Endo-Surgery Inc., Cincinnati, Ohio, USA.
authors.forename: James F
authors.initials: JF
authors.lastname: Martin
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona, USA.
authors.forename: Douglas O
authors.initials: DO
authors.lastname: Faigel
mesh_terms: D000328:Adult; D000368:Aged; D000776:Anesthesiology / Q000706:statistics & numerical data*; D003113:Colonoscopy / Q000706:statistics & numerical data; D016292:Procedural Sedation / Q000009:adverse effects*; D016099:Endoscopy, Gastrointestinal / Q000706:statistics & numerical data*; D005260:Female; D006304:Health Status; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D061214:Patient Safety; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D006993:Hypnotics and Sedatives