Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Melbourne, Australia
Anaesthesia, Perioperative and Pain Medicine Unit, University of Melbourne, Melbourne, Australia.
Br J Anaesth. 2017 Jan;118(1):90-99. doi: 10.1093/bja/aew393.
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.
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.
2,132 patients were included. Fifty percent of patients were aged >60 yr, 50% had a BMI >27 kg m , 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 , 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.
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.
胃肠道内镜镇静的服务模式必须是安全的，因为在许多国家，内镜检查是在镇静下进行的最常见的程序。本前瞻性队列研究的目的是确定患者的风险状况，以及在一组由麻醉师管理镇静的大学附属医院就诊的成年患者中，出现重大非计划性事件的发生率和危险因素。
纳入在澳大利亚墨尔本大学附属的 9 家医院接受麻醉师管理镇静下的择期和急诊胃肠道内镜检查的年龄≥18 岁的患者。主要结局包括严重气道阻塞、缺氧、低血压和心动过缓；计划性气管插管；放弃操作；高级生命支持；术后延长留观时间；计划性过夜入院和 30 天死亡率。
共纳入 2132 例患者。50%的患者年龄>60 岁，50%的患者 BMI>27kg/m2，42%的患者 ASA 体格状况为 III-V 级，17%为急诊患者。重大非计划性事件的发生率为 23.0%（包括严重低血压 11.8%）。重大术中非计划性事件与年龄增加、BMI<18.5kg/m2、ASA 体格状况 III-V 级、结肠镜检查和计划性气管插管有关。30 天死亡率为 1.2%（择期为 0.2%，急诊为 6.0%），与 ASA 体格状况 IV-V 级和急诊状态有关。
在一组由麻醉师管理镇静的公立大学附属医院就诊的胃肠道内镜患者，具有较高的风险特征，重大非计划性术中事件和 30 天死亡率较高。
