Safety of sedation for gastrointestinal endoscopy in a group of university-affiliated hospitals: a prospective cohort study

被引：64

作者：

Leslie, K. ^{[1
,2
,3
,4
]}

Allen, M. L. ^{[1
,2
,5
]}

Hessian, E. C. ^{[2
,6
]}

Peyton, P. J. ^{[7
,8
]}

Kasza, J. ^{[4
]}

Courtney, A. ^{[1
]}

Dhar, P. A. ^{[5
]}

Briedis, J. ^{[9
]}

Lee, S. ^{[9
]}

Beeton, A. R. ^{[10
]}

Sayakkarage, D. ^{[10
]}

Palanivel, S. ^{[11
]}

Taylor, J. K. ^{[12
]}

Haughton, A. J. ^{[13
]}

O'Kane, C. X. ^{[13
]}

机构：

[1] Royal Melbourne Hosp, Dept Anaesthesia & Pain Management, Melbourne, Vic, Australia

[2] Univ Melbourne, Anaesthesia Perioperat & Pain Med Unit, Melbourne, Vic, Australia

[3] Univ Melbourne, Dept Pharmacol & Therapeut, Melbourne, Vic, Australia

[4] Monash Univ, Dept Epidemiol & Prevent Med, Melbourne, Vic, Australia

[5] Peter MacCallum Canc Ctr, Dept Canc Anaesthesia Pain & Perioperat Med, Melbourne, Vic, Australia

[6] Western Hosp, Dept Anaesthesia & Pain Med, Melbourne, Vic, Australia

[7] Austin Hosp, Dept Anaesthesia, Melbourne, Vic, Australia

[8] Univ Melbourne, Dept Surg, Melbourne, Vic, Australia

[9] Northern Hosp, Dept Anaesthesia & Perioperat Med, Melbourne, Vic, Australia

[10] Goulburn Valley Base Hosp, Dept Anaesthesia, Shepparton, Australia

[11] Ballarat Base Hosp, Dept Anaesthesia, Ballarat, Vic, Australia

[12] St Vincents Hosp, Dept Anaesthesia, Melbourne, Vic, Australia

[13] Wangaratta Base Hosp, Dept Anaesthesia, Wangaratta, Australia

来源：

BRITISH JOURNAL OF ANAESTHESIA | 2017年 / 118卷 / 01期

关键词：

anaesthesia; complications; gastrointestinal endoscopy; sedation; RANDOMIZED CONTROLLED-TRIAL; PROPOFOL SEDATION; ANESTHESIA CARE; INTRAOPERATIVE HYPOTENSION; NONCARDIAC SURGERY; GI ENDOSCOPY; COLONOSCOPY; MORBIDITY; MORTALITY; PRESSURE;

D O I：

10.1093/bja/aew393

中图分类号：

R614 [麻醉学];

学科分类号：

100217 ;

摘要：

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.

引用

页码：90 / 99

页数：10

共 31 条

[1] Adverse events during monitored anesthesia care for GI endoscopy: an 8-year experience [J].