Deep Sedation Using Propofol Target-controlled Infusion for Gastrointestinal Endoscopic Procedures

A Retrospective Cohort Study

María E. García Guzzo; María S. Fernandez; Delfina Sanchez Novas; Sandra S. Salgado; Sergio A. Terrasa; Gonzalo Domenech; Carlos A. Teijido

Disclosures

BMC Anesthesiol. 2020;20(195) 

In This Article

Results

Medical records of 823 patients who underwent elective outpatient GIEPs under propofol TCI sedation were reviewed. Patients were aged 59.2 ± 14.1 years, 85% had ASA physical status classification scores I–II, and the mean BMI was 27.5 ± 4.8. The most frequently detected comorbidities were arterial hypertension (40.5%) and dyslipidaemia (34.5%) (Table 1).

The most commonly performed procedure was colonoscopy alone (48.36%), followed by combined (EGD and colonoscopy) procedures (37.47%) (Table 2). The mean propofol dose was 291.2 ± 124.6 mg. Fentanyl was administered by 86.88% of anaesthetists combined with propofol at a mean dose of 0.77 ± 0.25 mcg kg− 1. The global mean procedure duration was 25.07 ± 11.43 min (Table 2).

The most frequently encountered adverse event was SaO2 < 95%, with an incidence of 22.36% (184/823). Vasoactive drug administration and arterial hypotension followed, with incidences of 19.2% (158/823) and 12.64% (104/823), respectively. The incidence of SaO2 < 90% was 6.92% (57/823), while the incidence of bradycardia or chronotropic drug requirement was 4.73% (39/823). Only 0.5% of patients (4/823) required advanced airway management (unplanned SGD insertion or orotracheal intubation). No patients required ACLS or died during the procedure (Table 3). All patients were transferred to the PACU immediately after completion of the procedure and received home discharge at a mean post-procedure time of 43.1 ± 12.5 min.

During the post-anaesthetic period, the most frequent adverse event was arterial hypotension with an incidence of 4.6% (38/823), followed by SaO2 < 95% events with an incidence of 0.12% (1/823). No patients presented events of SaO2 < 90%. The incidence of nausea/vomiting episodes was 0.6% (5/823). No patients required advanced airway management or ACLS during this period (Table 3).

Multivariate analysis revealed a statistically significant association between obesity (BMI > 30) and the incidence of SaO2 < 90% events (Table 4). This association depicted a strong dose–effect relationship; taking non-obese patients as a reference, the risk of those with BMI 30–35 (grade 1 obesity) was almost double, with an OR of 1,68 (CI 95% 0.84 to 3.32), while patients with BMI 35–40 (grade 2, severe obesity) and BMI ≥40 (grade 3, morbid obesity) were three times (OR 2.85, CI 95% 1.09 to 7.46) and nine times (OR 10.22, CI 95% 2.83 to 36.99) more likely to experience SaO2 < 90% events, respectively.

For arterial hypotension events, multivariate analysis showed a statistically significant association between these events and both colonoscopic procedures and propofol doses (OR 3.08, 95% CI 1.43–6.61; P = 0.004 and OR 1.14, 95% CI 1.00–1.29; P = 0.046, respectively) (Table 5). After adjustment for potential confounders, a linear regression analysis showed a non-significant trend towards a reduction of 0.53 mg.kg- (95% CI − 0.86–0.2) in total propofol doses by concomitant fentanyl administration.

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