Yang Juliana F, Farooq Priya, Zwilling Kate, Patel Devi, Siddiqui Ali A
Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, 19107, USA.
Dig Dis Sci. 2016 Jun;61(6):1686-91. doi: 10.1007/s10620-016-4043-3. Epub 2016 Jan 29.
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 <90 mmHg), 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 25.2 kg/m(2), and the median ASA score was 3. The mean (±SD) duration of the procedures was 59 ± 23 min. 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.
在内镜检查中使用丙泊酚镇静可能会导致从深度镇静迅速发展为全身麻醉，且过程不可预测，从而引发潜在并发症。我们调查了在接受门诊内镜逆行胰胆管造影（ERCP）手术并使用丙泊酚镇静的非插管患者中，镇静相关不良事件（SAEs）的发生率及预测因素。
我们对接受ERCP手术丙泊酚镇静的患者进行了一项回顾性研究。患者使用丙泊酚联合小剂量阿片类药物进行镇静。收集的数据包括患者人口统计学资料、美国麻醉医师协会（ASA）身体状况分级及手术时间。SAE包括低氧血症（脉搏血氧饱和度<90%）、低血压（收缩压<90 mmHg）以及转为气管插管。通过单因素分析和多因素回归分析（MVA）研究与SAEs相关的因素。
共评估了3041例患者。中位体重指数（BMI）为25.2 kg/m²，中位ASA评分是3。手术平均（±标准差）时长为59±23分钟。28%（n = 843）的患者发生需要气道处理的低氧血症，0.4%（n = 12）的患者发生需要血管活性药物的低血压。49例（1.6%）患者因胃内有食物而需要气管插管。8例（0.3%）手术因镇静相关低血压（n = 5）和难治性喉痉挛（n = 3）而提前终止。6例患者在ERCP术后因镇静导致误吸性肺炎而入院。发生SAEs的患者年龄更大，平均BMI更高，平均手术时长更长。在MVA中，年龄较大（p = 0.003）、女性（p = 0.001）、BMI（p = 0.02）以及ASA分级≥3（p = 0.01）是SAEs的独立预测因素。
当由经过培训的专业人员给药时，丙泊酚可作为接受ERCP手术患者的一种安全有效的镇静剂。年龄、女性、BMI以及ASA分级≥3是SAEs的独立预测因素。
