García Guzzo María E, Fernandez María S, Sanchez Novas Delfina, Salgado Sandra S, Terrasa Sergio A, Domenech Gonzalo, Teijido Carlos A
Department of Anesthesiology, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Presidente Teniente General Juan Domingo Perón 4190, 1199, Buenos Aires, Argentina.
Department of Research, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Presidente Teniente General Juan Domingo Perón 4190, 1199, Buenos Aires, Argentina.
BMC Anesthesiol. 2020 Aug 10;20(1):195. doi: 10.1186/s12871-020-01103-w.
Propofol sedation is effective for gastrointestinal endoscopic procedures, but its narrow therapeutic window highlights the importance of identifying an optimal administration technique regarding effectiveness and safety. This study aimed to determine the incidence of significant adverse events in adult patients scheduled for gastrointestinal endoscopy under anaesthetist-performed sedation using propofol target-controlled infusion and determine the existence of associations between these events and potentially related variables.
This single-centre, retrospective cohort study took place in a tertiary referral university hospital. Medical records of 823 patients (age > 18 years, American Society of Anesthesiologists physical status classification scores I-III) who had undergone elective gastrointestinal endoscopy under propofol target-controlled infusion sedation during September 2018 were reviewed. Outcomes included hypoxia, hypotension, and bradycardia events, requirement of vasoactive drugs, unplanned tracheal intubation or supraglottic device insertion, and need for advanced cardiac life support.
The most frequently encountered adverse event was oxygen desaturation < 95% with an incidence of 22.35%. Vasoactive drug administration, hypotension, and oxygen desaturation < 90% followed, with incidences of 19.2, 12.64, and 9.92%, respectively. Only 0.5% of patients required advanced airway management. Multivariate analysis revealed an association between hypotension events, colonoscopic procedures, and propofol doses (odds ratio: 3.08, 95% confidence interval: 1.43 to 6.61; P = 0.004 and odds ratio: 1.14, 95% confidence interval: 1.00 to 1.29; P = 0.046). A strong dose-effect relationship was found between hypoxia and obesity; patients with body mass index ≥40 were nine times (odds ratio: 10.22, 95% confidence interval: 2.83 to 36.99) more likely to experience oxygen desaturation < 90% events.
Propofol sedation using target-controlled infusion appears to be a safe and effective anaesthetic technique for gastrointestinal endoscopic procedures with acceptable rates of adverse events and could be more widely adopted in clinical practice.
丙泊酚镇静用于胃肠内镜检查有效，但其治疗窗窄凸显了确定有效性和安全性方面最佳给药技术的重要性。本研究旨在确定计划在麻醉医生实施的丙泊酚靶控输注镇静下进行胃肠内镜检查的成年患者中严重不良事件的发生率，并确定这些事件与潜在相关变量之间是否存在关联。
这项单中心回顾性队列研究在一家三级转诊大学医院进行。回顾了2018年9月期间823例（年龄>18岁，美国麻醉医师协会身体状况分级评分I - III）在丙泊酚靶控输注镇静下接受择期胃肠内镜检查的患者的病历。结局包括低氧血症、低血压、心动过缓事件、血管活性药物的使用需求、非计划性气管插管或声门上装置插入以及高级心脏生命支持的需求。
最常发生的不良事件是氧饱和度<95%，发生率为22.35%。其次是血管活性药物的使用、低血压和氧饱和度<90%，发生率分别为19.2%、12.64%和9.92%。仅0.5%的患者需要高级气道管理。多因素分析显示低血压事件、结肠镜检查和丙泊酚剂量之间存在关联（比值比：3.08，95%置信区间：1.43至6.61；P = 0.004，比值比：1.14，95%置信区间：1.00至1.29；P = 0.046）。发现低氧血症与肥胖之间存在强剂量 - 效应关系；体重指数≥40的患者发生氧饱和度<90%事件的可能性高9倍（比值比：10.22，95%置信区间：2.83至36.99）。
使用靶控输注的丙泊酚镇静似乎是一种安全有效的胃肠内镜检查麻醉技术，不良事件发生率可接受，可在临床实践中更广泛采用。
