Angelika Behrens 1 , Anton Kreuzmayr 2 , Hendrik Manner 3 , Herbert Koop 4 , Albrecht Lorenz 4 , Claus Schaefer 5 , Mathais Plauth 6 , Jens-Uwe Jetschmann 6 , Christian von Tirpitz 7 , Marcus Ewald 8 , Michael Sackmann 9 , Wanja Renner 9 , Martin Krüger 10 , Dieter Schwab 11 , Werner Hoffmann 12 , Olaf Engelke 12 , Oliver Pech 13 , Frank Kullmann 14 , Sonja Pampuch 14 , Berthold Lenfers 15 , Uwe Weickert 16 , Dieter Schilling 17 , Stephan Boehm 18 , Susanne Beckebaum 18 , Vito Cicinnati 18 , Joachim F Erckenbrecht 19 , Franz Ludwig Dumoulin 20 , Claus Benz 21 , Thomas Rabenstein 22 , Georg Haltern 23 , Martin Balsliemke 23 , Christian de Mas 24 , Gerhard Kleber 25 , Christian Pehl 26 , Christoph Vogt 27 , Ralf Kiesslich 28 , Wolfgang Fischbach 29 , Irmtraut Koop 30 , Jens Kuehne 31 , Matthias Breidert 32 , Nils Lennart Sass 33 , Andrea May 34 , Christian Friedrich 34 , Ronni Veitt 35 , Rainer Porschen 36 , Mark Ellrichmann 37 , Alexander Arlt 37 , Wolfgang Schmitt 38 , Markus Dollhopf 38 , Werner Schmidbaur 39 , Axel Dignass 40 , Volker Schmitz 41 , J Labenz 42 , Gernot Kaiser 43 , Alexander Krannich 44 , Nico Barteska 45 , Christian Ell 34 Show Affiliations »
Abstract
OBJECTIVES: Sedation has been established for GI endoscopic procedures in most countries, but it is also associated with an added risk of complications. Reported complication rates are variable due to different study methodologies and often limited sample size. DESIGNS: Acute sedation-associated complications were prospectively recorded in an electronic endoscopy documentation in 39 study centres between December 2011 and August 2014 (median inclusion period 24 months). The sedation regimen was decided by each study centre. RESULTS: A total of 368 206 endoscopies was recorded; 11% without sedation. Propofol was the dominant drug used (62% only, 22.5% in combination with midazolam). Of the sedated patients, 38 (0.01%) suffered a major complication, and overall mortality was 0.005% (n=15); minor complications occurred in 0.3%. Multivariate analysis showed the following independent risk factors for all complications: American Society of Anesthesiologists class >2 (OR 2.29) and type and duration of endoscopy. Of the sedation regimens, propofol monosedation had the lowest rate (OR 0.75) compared with midazolam (reference) and combinations (OR 1.0-1.5). Compared with primary care hospitals, tertiary referral centres had higher complication rates (OR 1.61). Notably, compared with sedation by a two-person endoscopy team (endoscopist/assistant; 53.5% of all procedures), adding another person for sedation (nurse, physician) was associated with higher complication rates (ORs 1.40-4.46), probably due to higher complexity of procedures not evident in the multivariate analysis. CONCLUSIONS: This large multicentre registry study confirmed that severe acute sedation-related complications are rare during GI endoscopy with a very low mortality. The data are useful for planning risk factor-adapted sedation management to further prevent sedation-associated complications in selected patients. TRIAL REGISTRATION NUMBER: DRKS00007768; Pre-results. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2019. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
OBJECTIVES: Sedation has been established for GI endoscopic procedures in most countries, but it is also associated with an added risk of complications. Reported complication rates are variable due to different study methodologies and often limited sample size. DESIGNS: Acute sedation-associated complications were prospectively recorded in an electronic endoscopy documentation in 39 study centres between December 2011 and August 2014 (median inclusion period 24 months). The sedation regimen was decided by each study centre. RESULTS: A total of 368 206 endoscopies was recorded; 11% without sedation. Propofol was the dominant drug used (62% only, 22.5% in combination with midazolam ). Of the sedated patients , 38 (0.01%) suffered a major complication, and overall mortality was 0.005% (n=15); minor complications occurred in 0.3%. Multivariate analysis showed the following independent risk factors for all complications: American Society of Anesthesiologists class >2 (OR 2.29) and type and duration of endoscopy. Of the sedation regimens, propofol monosedation had the lowest rate (OR 0.75) compared with midazolam (reference) and combinations (OR 1.0-1.5). Compared with primary care hospitals, tertiary referral centres had higher complication rates (OR 1.61). Notably, compared with sedation by a two-person endoscopy team (endoscopist/assistant; 53.5% of all procedures), adding another person for sedation (nurse, physician) was associated with higher complication rates (ORs 1.40-4.46), probably due to higher complexity of procedures not evident in the multivariate analysis. CONCLUSIONS: This large multicentre registry study confirmed that severe acute sedation-related complications are rare during GI endoscopy with a very low mortality. The data are useful for planning risk factor-adapted sedation management to further prevent sedation-associated complications in selected patients . TRIAL REGISTRATION NUMBER: DRKS00007768; Pre-results. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2019. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
Entities: Chemical
Species
Keywords:
cardiovascular complications; gastrointesinal endoscopy
Year: 2018
PMID： 29298872 DOI： 10.1136/gutjnl-2015-311037
Source DB: PubMed Journal: Gut ISSN： 0017-5749 Impact factor: 23.059