Acute sedation-related complications occur rarely during GI endoscopy
Sedation during gastrointestinal (GI) endoscopy appears to be carried out with a high degree of safety, such that severe acute sedation-related complications occur rarely, a study has reported.
Researchers recorded acute sedation-associated complications using an electronic endoscopy documentation in 39 study centres between 2011 and 2014 (median inclusion period, 24 months), with the sedation regimen decided by each study centre.
A total of 368,206 endoscopies were recorded, of which 11 percent were performed without sedation. Propofol was the most commonly used drug, administered alone in 62 percent and in combination with midazolam in 22.5 percent.
In the group of sedated patients, 0.01 and 0.3 percent developed major and minor complications, respectively. The overall mortality rate was 0.005 percent (n=15). On multivariate logistic regression analysis, factors independently associated with all complications included American Society of Anesthesiologists class >2 (odds ratio [OR], 2.29) and type and duration of endoscopy.
Among the sedation regimens, propofol was associated with the lowest rate of complication (OR, 0.75) compared with midazolam and combinations (OR, 1.0 to 1.5). Complication rates were higher in tertiary referral centres than in primary care hospitals (OR, 1.61).
Of note, when compared with sedation by a two-person endoscopy team (endoscopist/assistant; 53.5 percent of all procedures), the addition of another person for sedation (nurse or physician) appeared to lead to higher complication rates (ORs, 1.40–4.46). Researchers explained that this was probably due to higher complexity of procedures not evident in the analysis.
The present data suggest that one severe sedation-related complication (serious adverse event) can be expected in one out of 10,000 endoscopies, and mortality rate was five per 100,000, researchers said. Moreover, propofol alone should be the preferred sedation for the vast majority of endoscopy patients.
“Our analysis of risk factors will enable more targeted sedation logistics especially in patients who are at increased risk. This will likely help to avoid and further reduce sedation-associated complications during GI endoscopy,” they added.