BACKGROUND: Deep sedation is increasingly used for endoscopy. The impact of sedation level on hemodynamic status, oxygenation, and aspiration risk is incompletely described. AIMS: To describe the incidence of intraprocedural cough, hemodynamic changes, oxygen desaturation, and their relationship to clinical factors and sedation level. METHODS: Detailed prospective recordings of hemodynamic changes, oxygen desaturation, and cough during 757 nonemergent endoscopic procedures done under sedation using propofol, midazolam, and/or fentanyl. RESULTS: Thirteen percent of patients had at least one cough and 3% had prolonged cough. Cough was more common in nonsmokers (P = 0.05), upper endoscopy (P < 0.0001), with propofol (P = 0.0008), longer procedures (P = 0.0001), and hiccups (P = 0.01). The association between supine positioning during colonoscopy and cough approached significance (P = 0.06). Oxygen desaturation was rare (4%) and associated only with deep sedation (P = 0.02). Mean systolic and diastolic blood pressure (BP) dropped by 7.3 and 5.6% respectively. Decreases in systolic BP were more common in whites (P = 0.03), males (P = 0.004), nonsmokers (P = 0.04), during colonoscopy (P < 0.0001), and in patients receiving midazolam and fentanyl (P = 0.01). Heart rate (HR) dropped >20% from baseline in 15% of patients and was more common during colonoscopy (P = 0.002). HR increased >20% in 20% of patients and was more common with coughing (P < 0.0001) and in younger patients (P = 0.0002). No patient required pharmacologic treatment of BP or HR. CONCLUSIONS: We have described procedural predictors of cough that may help clinicians reduce the risk of aspiration during endoscopy. Hemodynamic changes during endoscopy are common but largely clinically insignificant.
BACKGROUND: Deep sedation is increasingly used for endoscopy. The impact of sedation level on hemodynamic status, oxygenation, and aspiration risk is incompletely described. AIMS: To describe the incidence of intraprocedural cough, hemodynamic changes, oxygen desaturation, and their relationship to clinical factors and sedation level. METHODS: Detailed prospective recordings of hemodynamic changes, oxygen desaturation, and cough during 757 nonemergent endoscopic procedures done under sedation using propofol, midazolam, and/or fentanyl. RESULTS: Thirteen percent of patients had at least one cough and 3% had prolonged cough. Cough was more common in nonsmokers (P = 0.05), upper endoscopy (P < 0.0001), with propofol (P = 0.0008), longer procedures (P = 0.0001), and hiccups (P = 0.01). The association between supine positioning during colonoscopy and cough approached significance (P = 0.06). Oxygen desaturation was rare (4%) and associated only with deep sedation (P = 0.02). Mean systolic and diastolic blood pressure (BP) dropped by 7.3 and 5.6% respectively. Decreases in systolic BP were more common in whites (P = 0.03), males (P = 0.004), nonsmokers (P = 0.04), during colonoscopy (P < 0.0001), and in patients receiving midazolam and fentanyl (P = 0.01). Heart rate (HR) dropped >20% from baseline in 15% of patients and was more common during colonoscopy (P = 0.002). HR increased >20% in 20% of patients and was more common with coughing (P < 0.0001) and in younger patients (P = 0.0002). No patient required pharmacologic treatment of BP or HR. CONCLUSIONS: We have described procedural predictors of cough that may help clinicians reduce the risk of aspiration during endoscopy. Hemodynamic changes during endoscopy are common but largely clinically insignificant.
Authors: Gregory A Coté; Robert M Hovis; Michael A Ansstas; Lawrence Waldbaum; Riad R Azar; Dayna S Early; Steven A Edmundowicz; Daniel K Mullady; Sreenivasa S Jonnalagadda Journal: Clin Gastroenterol Hepatol Date: 2009-07-14 Impact factor: 11.382
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Authors: Douglas K Rex; Viju P Deenadayalu; Emely Eid; Thomas F Imperiale; John A Walker; Kuldip Sandhu; Anthony C Clarke; Lybus C Hillman; Akira Horiuchi; Lawrence B Cohen; Ludwig T Heuss; Shajan Peter; Christoph Beglinger; James A Sinnott; Thomas Welton; Magdy Rofail; Iyad Subei; Rodger Sleven; Paul Jordan; John Goff; Patrick D Gerstenberger; Harold Munnings; Martin Tagle; Brian W Sipe; Till Wehrmann; Jack A Di Palma; Kaitlin E Occhipinti; Egidio Barbi; Andrea Riphaus; Stephen T Amann; Gen Tohda; Timothy McClellan; Charles Thueson; John Morse; Nizam Meah Journal: Gastroenterology Date: 2009-06-21 Impact factor: 22.682
Authors: Aoife M Feighery; Nicholas R Oblizajek; Matthew N P Vogt; Danse Bi; John League; Navtej S Buttar; David O Prichard Journal: Dig Dis Sci Date: 2022-05-21 Impact factor: 3.199