K Leslie1,2,3,4, M L Allen5,2,6, E C Hessian2,7, P J Peyton8,9, J Kasza4, A Courtney5, P A Dhar6, J Briedis10, S Lee10, A R Beeton11, D Sayakkarage11, S Palanivel12, J K Taylor13, A J Haughton14, C X O'Kane14. 1. Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Melbourne, Australia kate.leslie@mh.org.au. 2. Anaesthesia, Perioperative and Pain Medicine Unit, University of Melbourne, Melbourne, Australia. 3. Department of Pharmacology and Therapeutics, University of Melbourne, Melbourne, Australia. 4. Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia. 5. Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Melbourne, Australia. 6. Department of Cancer Anaesthesia, Pain and Perioperative Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia. 7. Department of Anaesthesia and Pain Medicine, Western Hospital, Melbourne, Australia. 8. Department of Anaesthesia, Austin Hospital, Melbourne, Australia. 9. Department of Surgery, University of Melbourne, Melbourne, Australia. 10. Department of Anaesthesia and Perioperative Medicine, Northern Hospital, Melbourne, Australia. 11. Department of Anaesthesia, Goulburn Valley Base Hospital, Shepparton, Australia. 12. Department of Anaesthesia, Ballarat Base Hospital, Ballarat, Australia. 13. Department of Anaesthesia, St Vincent's Hospital, Melbourne, Australia. 14. Department of Anaesthesia, Wangaratta Base Hospital, Wangaratta, Australia.
Abstract
BACKGROUND: Service models for gastrointestinal endoscopy sedation must be safe, as endoscopy is the most common procedure performed under sedation in many countries. The aim of this prospective cohort study was to determine the patient risk profile, and incidence of and risk factors for significant unplanned events, in adult patients presenting for gastrointestinal endoscopy in a group of university-affiliated hospitals where most sedation is managed by anaesthetists. METHODS: Patients aged ≥18 yr presenting for elective and emergency gastrointestinal endoscopy under anaesthetist-managed sedation at nine hospitals affiliated with the University of Melbourne, Australia, were included. Outcomes included significant airway obstruction, hypoxia, hypotension and bradycardia; unplanned tracheal intubation; abandoned procedure; advanced life support; prolonged post-procedure stay; unplanned over-night admission and 30-day mortality. RESULTS: 2,132 patients were included. Fifty percent of patients were aged >60 yr, 50% had a BMI >27 kg m -2, 42% were ASA physical status III-V and 17% were emergency patients. The incidence of significant unplanned events was 23.0% (including significant hypotension 11.8%). Significant unplanned intraoperative events were associated with increasing age, BMI <18.5 kg m -2, ASA physical status III-V, colonoscopy and planned tracheal intubation. Thirty-day mortality was 1.2% (0.2% in electives and 6.0% in emergencies) and was associated with ASA physical status IV-V and emergency status. CONCLUSIONS: Patients presenting for gastrointestinal endoscopy at a group of public university-affiliated hospitals where most sedation is managed by anaesthetists, had a high risk profile and a substantial incidence of significant unplanned intraoperative events and 30-day mortality.
BACKGROUND: Service models for gastrointestinal endoscopy sedation must be safe, as endoscopy is the most common procedure performed under sedation in many countries. The aim of this prospective cohort study was to determine the patient risk profile, and incidence of and risk factors for significant unplanned events, in adult patients presenting for gastrointestinal endoscopy in a group of university-affiliated hospitals where most sedation is managed by anaesthetists. METHODS:Patients aged ≥18 yr presenting for elective and emergency gastrointestinal endoscopy under anaesthetist-managed sedation at nine hospitals affiliated with the University of Melbourne, Australia, were included. Outcomes included significant airway obstruction, hypoxia, hypotension and bradycardia; unplanned tracheal intubation; abandoned procedure; advanced life support; prolonged post-procedure stay; unplanned over-night admission and 30-day mortality. RESULTS: 2,132 patients were included. Fifty percent of patients were aged >60 yr, 50% had a BMI >27 kg m -2, 42% were ASA physical status III-V and 17% were emergency patients. The incidence of significant unplanned events was 23.0% (including significant hypotension 11.8%). Significant unplanned intraoperative events were associated with increasing age, BMI <18.5 kg m -2, ASA physical status III-V, colonoscopy and planned tracheal intubation. Thirty-day mortality was 1.2% (0.2% in electives and 6.0% in emergencies) and was associated with ASA physical status IV-V and emergency status. CONCLUSIONS:Patients presenting for gastrointestinal endoscopy at a group of public university-affiliated hospitals where most sedation is managed by anaesthetists, had a high risk profile and a substantial incidence of significant unplanned intraoperative events and 30-day mortality.
Authors: María E García Guzzo; María S Fernandez; Delfina Sanchez Novas; Sandra S Salgado; Sergio A Terrasa; Gonzalo Domenech; Carlos A Teijido Journal: BMC Anesthesiol Date: 2020-08-10 Impact factor: 2.217
Authors: Caetano Nigro Neto; Francisco José Lucena Bezerra; Rodrigo Bellio de Mattos Barreto; Davi Costa de Souza Le Bihan; Vinicius Tadeu Nogueira da Silva do Nascimento; Ingrid Caroline Baia de Souza Journal: Braz J Anesthesiol Date: 2020-05-13