Identifying who best tolerates moderate sedation: Results from a national database of gastrointestinal endoscopic outcomes.
Anesthesia
Gastrointestinal endoscopy
Moderate (conscious) sedation
Sedation tolerance
Journal
World journal of gastrointestinal endoscopy
ISSN: 1948-5190
Titre abrégé: World J Gastrointest Endosc
Pays: United States
ID NLM: 101532474
Informations de publication
Date de publication:
16 Apr 2021
16 Apr 2021
Historique:
received:
06
01
2021
revised:
19
02
2021
accepted:
11
03
2021
entrez:
7
5
2021
pubmed:
8
5
2021
medline:
8
5
2021
Statut:
ppublish
Résumé
With increasing volume and cost of gastrointestinal endoscopic procedures, the proper selection of patients for moderate sedation becomes increasingly relevant. The current literature lacks consistent findings that allow for appropriate selection of patients for moderate sedation. To analyze a nationwide registry of patients to identify patient and procedural factors associated with lower sedation requirements for endoscopy. The Clinical Outcomes Research Initiative National Endoscopic Database was queried to assess adult patients undergoing moderate sedation for esophagogastroduodenoscopy (EGD) and colonoscopy from 2008 to 2014. Patients were stratified into two groups [low dose (LD) and high dose sedation] based on sedation requirements. Anthropometric, procedural, and anesthesia data were compared, and multivariable analysis was performed to identify factors associated with LD sedation. Of the 371102 patients included in the study, 63137 where stratified into the LD sedation group and 307965 were in the high dose group. Moderate sedation was managed primarily by endoscopists (50%) and anesthesia providers (47%). Patients undergoing EGDs and procedures performed in the inpatient setting, in ambulatory surgery centers, intensive care units or hospital wards, required less sedation than colonoscopies, outpatient procedures and procedures done in endoscopy suites, respectively ( Clinicians should consider these patient profiles in determining which patients will better tolerate moderate sedation
Sections du résumé
BACKGROUND
BACKGROUND
With increasing volume and cost of gastrointestinal endoscopic procedures, the proper selection of patients for moderate sedation becomes increasingly relevant. The current literature lacks consistent findings that allow for appropriate selection of patients for moderate sedation.
AIM
OBJECTIVE
To analyze a nationwide registry of patients to identify patient and procedural factors associated with lower sedation requirements for endoscopy.
METHODS
METHODS
The Clinical Outcomes Research Initiative National Endoscopic Database was queried to assess adult patients undergoing moderate sedation for esophagogastroduodenoscopy (EGD) and colonoscopy from 2008 to 2014. Patients were stratified into two groups [low dose (LD) and high dose sedation] based on sedation requirements. Anthropometric, procedural, and anesthesia data were compared, and multivariable analysis was performed to identify factors associated with LD sedation.
RESULTS
RESULTS
Of the 371102 patients included in the study, 63137 where stratified into the LD sedation group and 307965 were in the high dose group. Moderate sedation was managed primarily by endoscopists (50%) and anesthesia providers (47%). Patients undergoing EGDs and procedures performed in the inpatient setting, in ambulatory surgery centers, intensive care units or hospital wards, required less sedation than colonoscopies, outpatient procedures and procedures done in endoscopy suites, respectively (
CONCLUSION
CONCLUSIONS
Clinicians should consider these patient profiles in determining which patients will better tolerate moderate sedation
Identifiants
pubmed: 33959232
doi: 10.4253/wjge.v13.i4.97
pmc: PMC8080537
doi:
Types de publication
Journal Article
Langues
eng
Pagination
97-110Informations de copyright
©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
Déclaration de conflit d'intérêts
Conflict-of-interest statement: All the authors have no conflict of interest related to the manuscript.
Références
Gastrointest Endosc. 2018 May;87(5):1297-1303
pubmed: 28159539
Am J Gastroenterol. 1994 Sep;89(9):1476-9
pubmed: 8079923
Pain Manag. 2012 May;2(3):219-230
pubmed: 23687518
J Clin Gastroenterol. 1997 Jun;24(4):220-3
pubmed: 9252844
Aliment Pharmacol Ther. 2006 Jul 15;24(2):163-71
pubmed: 16842446
Gastrointest Endosc. 2020 Mar;91(3):595-605.e3
pubmed: 31756314
Aliment Pharmacol Ther. 2014 Jul;40(1):72-82
pubmed: 24815064
Handb Exp Pharmacol. 2008;(182):335-60
pubmed: 18175099
Dig Liver Dis. 2011 Jul;43(7):553-8
pubmed: 21450542
World J Gastrointest Endosc. 2016 Dec 16;8(20):770-776
pubmed: 28042391
Gastroenterology. 2007 Aug;133(2):675-701
pubmed: 17681185
Virtual Mentor. 2013 May 01;15(5):449-54
pubmed: 23680568
Dig Dis Sci. 2012 Oct;57(10):2527-34
pubmed: 22565338
Gastrointest Endosc. 2006 Jan;63(1):87-94
pubmed: 16377322
Br J Clin Pharmacol. 2004 May;57(5):540-4
pubmed: 15089805
Gastrointest Endosc. 2018 Feb;87(2):327-337
pubmed: 29306520
Turk J Gastroenterol. 2009 Dec;20(4):271-5
pubmed: 20084571
Gastrointest Endosc. 2008 Nov;68(5):815-26
pubmed: 18984096
Scientifica (Cairo). 2013;2013:415279
pubmed: 24278778
J Natl Med Assoc. 2019 Dec;111(6):648-655
pubmed: 31587885
World J Gastroenterol. 2013 Jan 28;19(4):463-81
pubmed: 23382625
World J Gastrointest Endosc. 2015 Feb 16;7(2):102-9
pubmed: 25685266
Indian J Gastroenterol. 2017 Jul;36(4):330-331
pubmed: 28755264
Scand J Gastroenterol. 2010 Oct;45(10):1248-54
pubmed: 20560818
Gastrointest Endosc. 2012 Jul;76(1):e1-25
pubmed: 22624793