Safety Analysis of Bariatric Patients Undergoing Outpatient Upper Endoscopy with Non-Anesthesia Administered Propofol Sedation.

Abstract

Non-anesthesia administered propofol (NAAP) has been shown to be a safe and effective method of sedation for patients undergoing gastrointestinal endoscopy. Bariatric surgery patients are potentially at a higher risk for sedation-related complications due to co-morbidities including obstructive sleep apnea. The outcomes of NAAP in bariatric patients have not been previously reported. In this retrospective cohort study, severely obese patients undergoing pre-surgical outpatient esophagogastroduodenoscopy (EGD) were compared to non-obese control patients (BMI≤25kg/m2) undergoing diagnostic EGD at our institution from March 2011-September 2015 using our endoscopy database. Patients' demographics and procedural and recovery data, including any airway interventions, were statistically analyzed. We included 130 consecutive pre-operative bariatric surgical patients with average BMI 45.8kg/m2 (range 34-80) and 265 control patients with average BMI 21.9kg/m2 (range 14-25). The severely obese group had a higher prevalence of sleep apnea (62 vs 8%; p<0.001), experienced more oxygen desaturations (22 vs 7%; p<0.001), and received more chin lift maneuvers (20 vs 6%; p<0.001). Advanced airway interventions were rarely required in either group and were not more frequent in the bariatric group. With appropriate training of endoscopy personnel, NAAP is a safe method of sedation in severely obese patients undergoing outpatient upper endoscopy.