School of Anaesthesia, Severn Deanery, Bristol, UK.
University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK.
Can J Anaesth. 2023 Nov;70(11):1735-1743. doi: 10.1007/s12630-023-02593-1. Epub 2023 Oct 9.
Following demand, we established a patient-controlled propofol-remifentanil sedation service for endoscopy overseen by an anesthesiologist. To assess the effectiveness of the intervention of this service and any complications, we prospectively audited the service. Our primary outcomes of interest were adequacy of sedation and patient satisfaction. Secondary outcomes included any adverse events associated with the sedation.
Patients were referred for failure of procedure under endoscopist-administered sedation, refusal of procedure without general anesthesia (GA), or planned complex procedure. We included all 670 procedures performed between 2017 and 2021. We used a mixture of 8.9 mg·mL propofol and 5.4 µg·mL remifentanil with a 1-mL bolus and 20-sec lockout. We assessed the adequacy of sedation using the Modified Gloucester Scale and categorized adverse events according to the Tracking and Reporting Outcomes of Procedural Sedation.
All 670 procedures were accomplished with adequate sedation without the need for ventilation or GA, and all patients were satisfied with the sedation. The complication rate was low, with no sentinel airway or respiratory events. Nineteen out of 670 patients (2.8%) had an incidence of airway obstruction (requiring a simple airway maneuver). The body mass index (BMI) was documented in 18/19 of these patients and the average BMI in this group was 35 kg·m. Seven of the 670 patients (1%) had self-terminating apnea, 3/670 patients (0.4%) vomited, no patients aspirated, and 17/665 patients (2.6%) required a vasopressor to maintain blood pressure within 20% of preprocedure values.
The results from our prospective service audit indicate that propofol-remifentanil patient-controlled sedation is a safe and reliable technique in patients undergoing endoscopic procedures.
应需求，我们为接受麻醉医师监督的内镜检查建立了患者自控异丙酚-瑞芬太尼镇静服务。为了评估该服务的干预效果和任何并发症，我们前瞻性审核了该服务。我们关注的主要结果是镇静的充分性和患者满意度。次要结果包括与镇静相关的任何不良事件。
患者因内镜医师管理镇静下的程序失败、拒绝无全身麻醉（GA）的程序或计划进行复杂的程序而被转介。我们纳入了 2017 年至 2021 年期间进行的所有 670 例手术。我们使用混合 8.9 mg·mL 异丙酚和 5.4 µg·mL 瑞芬太尼，给予 1 毫升推注和 20 秒锁定。我们使用改良格洛斯特量表评估镇静的充分性，并根据《程序性镇静的追踪和报告结局》对不良事件进行分类。
所有 670 例手术均在无需通气或 GA 的情况下完成，所有患者对镇静均满意。并发症发生率低，无哨兵气道或呼吸事件。670 例患者中有 19 例（2.8%）发生气道阻塞（需要简单的气道操作）。这 19 例患者中有 18 例记录了体重指数（BMI），该组的平均 BMI 为 35 kg·m。670 例患者中有 7 例（1%）出现自行终止的呼吸暂停，3/670 例（0.4%）呕吐，无患者发生误吸，17/665 例（2.6%）需要血管加压药以维持血压在术前值的 20%以内。
前瞻性服务审核的结果表明，异丙酚-瑞芬太尼患者自控镇静在接受内镜检查的患者中是一种安全可靠的技术。
