Abstract
Propofol sedation for endoscopy may result in a rapid and unpredictable progression from deep sedation to general anesthesia, leading to potential complications. We investigated the incidence and predictors of sedation-related adverse events (SAEs) in nonintubated patients who underwent outpatient ERCP procedures with propofol sedation. We conducted a retrospective study of patients who underwent propofol sedation for ERCP procedures. Patients were sedated using propofol in combination with low-dose opiates. Data collected included patient demographics, American Society of Anesthesiologists (ASAs) physical status, and procedure times. SAE includes hypoxia (pulse oximetry <90%), hypotension (systolic blood pressure <90mmHg), and conversation to endotracheal intubation. Factors associated with SAEs were examined by univariate analysis and multivariate regression analysis (MVA). A total of 3041 patients were evaluated. The median BMI was 25.2kg/m(2), and the median ASA score was 3. The mean (±SD) duration of the procedures was 59±23min. Hypoxia requiring airway manipulation occurred in 28% (n=843) patients and hypotension requiring vasopressors in 0.4% (n=12). Forty-nine (1.6%) patients required endotracheal intubation as a result of food in the stomach. Procedures underwent early termination in 8 (0.3%) cases due to sedation-related hypotension (n=5) and refractory laryngospasm (n=3). Six patients were admitted after the ERCP for aspiration pneumonia as a result of sedation. Patients who developed SAE were older, had a higher mean BMI, and had longer mean procedure durations. On MVA, older age (p=0.003), female sex (p=0.001), BMI (p=0.02), and ASA class ≥3 (p=0.01) independently predicted SAEs. Propofol can be used safely and effectively as a sedative agent for patients undergoing ERCPs when administered by trained professionals. Age, female sex, BMI, and ASA class ≥3 are independent predictors of SAEs.
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