Abstract
BackgroundTo study the relationship between endoscopic practice and adverse events during colonoscopy under standard deep sedation induced and monitored by an anesthetist.MethodsWe investigated the routine activity of an endoscopy center at the Padova University teaching hospital. We considered not only endoscopic and cardiorespiratory complications, but also the need to use high-dose propofol to complete the procedure, and the inability to complete the procedure. Variables relating to the patient’s clinical conditions, bowel preparation, the endoscopist’s and the anesthetist’s experience, and the duration of the procedure were input in the model.Results617 procedures under deep sedation were performed with a 5% rate of adverse events. The average dose of propofol used was 2.6±1.2 mg/kg. In all, 14 endoscopists and 42 anesthetists were involved in the procedures. The logistic regression analysis identified female gender (OR=2.3), having the colonoscopy performed by a less experienced endoscopist (OR=1.9), inadequate bowel preparation (OR=3.2) and a procedure lasting longer than 17.5 minutes (OR=1.6) as the main risk factors for complications. An ASA score of 2 carried a 50% risk reduction (OR=0.5).Discussion and conclusionsOur model showed that none of the variables relating to anesthesiological issues influenced which procedures would prove difficult.
Highlights
To study the relationship between endoscopic practice and adverse events during colonoscopy under standard deep sedation induced and monitored by an anesthetist
It has been demonstrated that cardiorespiratory complications during a colonoscopy may be associated with anesthesiological practices due to an excessive dose of drug, inadequate patient monitoring, and/or an excessively rapid induction of sedation [10,11]
Our study shows that difficulties encountered during colonoscopy procedures cannot be explained, by variables relating to anesthesiological activity during deep sedation with propofol
Summary
To study the relationship between endoscopic practice and adverse events during colonoscopy under standard deep sedation induced and monitored by an anesthetist. Failure to complete a caecal intubation may be related to technical issues, the patient’s tolerance, and/or bowel preparation. On the other hand, such an approach has raised major concern regarding: Guidelines have been developed on the factors to consider in order to guarantee a safe procedure, since adverse events may depend on the endoscopist, and on the activities of the anesthetist, including the preliminary risk assessment and patient monitoring [8,9]. The use of deep sedation with propofol in colonoscopy is a controversial issue because it demands careful planning to maximize patients’ tolerance and minimize their risks for diagnostic, or relatively simple therapeutic procedures (such as polypectomy)
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