Simon I B, Lewis R J, Satava R M
Surgical Endoscopy Training Program, Silas B. Hays Army Community Hospital, Monterey (Fort Ord), California 93941.
Am Surg. 1991 Apr;57(4):219-21.
Although the incidence of significant complications occurring during endoscopic procedures that require sedation are low, it has been demonstrated that they are usually related to cardiovascular system dysfunction. Such complications are a manifestation of cardiac hypoxia and are a function of the arterial oxygen desaturation. A practical method of monitoring such patients includes continuous oxygen saturation measurements and EKG monitoring. From October, 1987 to July, 1989, a total of 730 endoscopic examinations were performed using a combination of meperidine and midazolam as an intravenous (IV) bolus for sedation. Supplemental nasal oxygen was routinely given at 2 L per minute and real-time monitoring was performed with electrocardiograph and continuous pulse oximeter. There were no deaths and only four untoward events related to medication that altered the course of the examination. Transient hypoxemia that responds to gentle stimulation and bradycardia resolving with cessation of endoscope advancement are viewed as physiologic responses and not complications. All occurrences were immediately identified and corrected appropriately, and no morbidity resulted. With proper monitoring of oxygen saturation, pulse, and cardiac rhythm in a patient with nasal oxygen, IV bolus administration of meperidine and midazolam is a safe and adequate sedation even in the elderly and debilitated patient.
尽管在需要镇静的内镜检查过程中发生严重并发症的发生率较低，但已证明这些并发症通常与心血管系统功能障碍有关。此类并发症是心脏缺氧的一种表现，并且是动脉血氧饱和度降低的结果。监测此类患者的一种实用方法包括连续测量血氧饱和度和进行心电图监测。1987年10月至1989年7月，总共进行了730例内镜检查，使用哌替啶和咪达唑仑联合静脉推注进行镇静。常规给予每分钟2升的补充鼻氧，并使用心电图仪和连续脉搏血氧仪进行实时监测。没有死亡病例，仅有4例与药物相关的不良事件改变了检查进程。对轻度刺激有反应的短暂性低氧血症以及随着内镜推进停止而缓解的心动过缓被视为生理反应而非并发症。所有情况均立即被识别并得到适当纠正，未导致任何发病情况。在给予鼻氧的患者中，通过适当监测血氧饱和度、脉搏和心律，静脉推注哌替啶和咪达唑仑即使对老年和体弱患者也是一种安全且充分的镇静方法。
