Año 2016 / Volumen 108 / Número 5
Original
Safety and risk factors for difficult endoscopist-directed ERCP sedation in daily practice: a hospital-based case-control study

240-245

DOI: 10.17235/reed.2016.4206/2016

Enrique Pérez-Cuadrado Robles, Abel González Ramírez, Ángel Lancho Seco, Eva Martí Marqués, Andrés Dacal Rivas, Elena Castro Ortiz, Roberto González Soler, Beatriz Álvarez Suárez, Dolores Tardáguila García, Alina López Baz, Alexia Fernández López, Leopoldo López Roses,

Resumen
Background: There are limited data concerning endoscopist-directed endoscopic retrograde cholangiopancreatography deep sedation. The aim of this study was to establish the safety and risk factors for difficult sedation in daily practice. Patients and methods: Hospital-based, frequency matched case-control study. All patients were identified from a database of 1,008 patients between 2014 and 2015. The cases were those with difficult sedations. This concept was defined based on the combination of the receipt of high-doses of midazolam or propofol, poor tolerance, use of reversal agents or sedation-related adverse events. The presence of different factors was evaluated to determine whether they predicted difficult sedation. Results: One-hundred and eighty-nine patients (63 cases, 126 controls) were included. Cases were classified in terms of high-dose requirements (n = 35, 55.56%), sedation-related adverse events (n = 14, 22.22%), the use of reversal agents (n = 13, 20.63%) and agitation/discomfort (n = 8, 12.7%). Concerning adverse events, the total rate was 1.39%, including clinically relevant hypoxemia (n = 11), severe hypotension (n = 2) and paradoxical reactions to midazolam (n = 1). The rate of hypoxemia was higher in patients under propofol combined with midazolam than in patients with propofol alone (2.56% vs. 0.8%, p < 0.001). Alcohol consumption (OR: 2.674 [CI 95%: 1.098-6.515], p = 0.030), opioid consumption (OR: 2.713 [CI 95%: 1.096-6.716], p = 0.031) and the consumption of other psychoactive drugs (OR: 2.015 [CI 95%: 1.017-3.991], p = 0.045) were confirmed to be independent risk factors for difficult sedation. Conclusions: Endoscopist-directed deep sedation during endoscopic retrograde cholangiopancreatography is safe. The presence of certain factors should be assessed before the procedure to identify patients who are high-risk for difficult sedation.
Share Button
Nuevo comentario
Comentarios
No hay comentarios para este artículo.
Bibliografía
[1] Sieg A; bng-Study-Group, Beck S, et al. Safety analysis of endoscopist-directed propofol sedation: a prospective, national multicenter study of 24 441 patients in German outpatient practices. J Gastroenterol Hepatol. 2014; 29:517-23.
[2] de Paulo GA, Martins FP, Macedo EP, et al. Sedation in gastrointestinal endoscopy: a prospective study comparing nonanesthesiologist-administered propofol and monitored anesthesia care. Endosc Int Open. 2015; 3:E7-E13.
[3] Poincloux L, Laquière A, Bazin JE, et al. A randomized controlled trial of endoscopist vs. anaesthetist-administered sedation for colonoscopy. Dig Liver Dis. 2011; 43:553-8.
[4] Molina-Infante J, Dueñas-Sadornil C, Mateos-Rodriguez JM, et al. Nonanesthesiologist-administered propofol versus midazolam and propofol, titrated to moderate sedation, for colonoscopy: a randomized controlled trial. Dig Dis Sci. 2012; 57:2385-93.
[5] Rex DK, Deenadayalu VP, Eid E, et al. Endoscopist-directed administration of propofol: a worldwide safety experience. Gastroenterology. 2009; 137:1229-37; quiz 1518-9.
[6] Sethi S, Wadhwa V, Thaker A, et al. Propofol versus traditional sedative agents for advanced endoscopic procedures: a meta-analysis. Dig Endosc. 2014; 26:515-24.
[7] Vargo JJ, Zuccaro G Jr, Dumot JA, et al. Gastroenterologist-administered propofol versus meperidine and midazolam for advanced upper endoscopy: a prospective, randomized trial. Gastroenterology. 2002;123:8-16.
[8] Khan HA, Umar M, Tul-Bushra H, et al. Safety of non-anaesthesiologist-administered propofol sedation in ERCP. Arab J Gastroenterol. 2014; 15:32-5.
[9] Mehta PP, Vargo JJ, Dumot JA, et al. Does anesthesiologist-directed sedation for ERCP improve deep cannulation and complication rates? Dig Dis Sci 2011; 56: 2185–90.
[10] Mazanikov M, Udd M, Kylänpää L, et al. A randomized comparison of target-controlled propofol infusion and patient-controlled sedation during ERCP. Endoscopy. 2013; 45:915-9.
[11] Riphaus A, Geist C, Schrader K, et al. Intermittent manually controlled versus continuous infusion of propofol for deep sedation during interventional endoscopy: a prospective randomized trial. Scand J Gastroenterol. 2012; 4):1078-85.
[12] Riphaus A, Stergiou N, Wehrmann T. Sedation with propofol for routine ERCP in high-risk octogenarians: a randomized, controlled study. Am J Gastroenterol. 2005; 10):1957-63.
[13] Goudra BG, Singh PM, Gouda G, et al. Safety of Non-anesthesia Provider-Administered Propofol (NAAP) Sedation in Advanced Gastrointestinal Endoscopic Procedures: Comparative Meta-Analysis of Pooled Results. Dig Dis Sci. 2015; 60:2612-27.
[14] Dumonceau JM, Riphaus A, Schreiber F, et al. Non-anesthesiologist administration of propofol for gastrointestinal endoscopy: European Society of Gastrointestinal Endoscopy, European Society of Gastroenterology and Endoscopy Nurses and Associates Guideline - Updated June 2015. Endoscopy. 2015; 47:1175-89.
[15] Igea F, Casellas JA, González-Huix F, et al. Clinical practice guidelines of the Sociedad Española de Endoscopia Digestiva. Rev Esp Enferm Dig. 2014; 106:195-211.
[16] Vargo JJ, Cohen LB, Rex DK, et al. Position statement: Nonanesthesiologist administration of propofol for GI endoscopy. Gastroenterology. 2009; 137:2161-7.
[17] Braunstein ED, Rosenberg R, Gress F, et al. Development and validation of a clinical prediction score (the SCOPE score) to predict sedation outcomes in patients undergoing endoscopic procedures. Aliment Pharmacol Ther. 2014; 40:72-82.
[18] Ikeuchi N, Itoi T, Gotoda T, et al. Feasibility of non-anesthesiologist-administered propofol sedation for emergency endoscopic retrograde cholangiopancreatography. Gastroenterol Res Pract. 2015; 2015:685476.
[19] Kongkam P, Rerknimitr R, Punyathavorn S, et al. Propofol infusion versus intermittent meperidine and midazolam injection for conscious sedation in ERCP. J Gastrointestin Liver Dis. 2008; 17:291-7.
[20] Barnett SR, Berzin T, Sanaka S, et al. Deep sedation without intubation for ERCP is appropriate in healthier, non-obese patients. Dig Dis Sci. 2013; 58:3287-92.
[21] Angsuwatcharakon P, Rerknimitr R, Ridtitid W, et al. Cocktail sedation containing propofol versus conventional sedation for ERCP: a prospective, randomized controlled study. BMC Anesthesiol. 2012;12:20.
Artículos relacionados

Carta

Blue rubber bleb nevus syndrome

DOI: 10.17235/reed.2023.9913/2023

Carta

Calcifying fibrous tumor and pathological analysis

DOI: 10.17235/reed.2023.9739/2023

Carta

Endoscopic observation of a rare duodenal tumor

DOI: 10.17235/reed.2023.9679/2023

Carta

Linfoma MALT de colon: un desafío endoscópico

DOI: 10.17235/reed.2023.9595/2023

Carta

Isolated Jejunal Crohn's Disease: a challenging diagnosis

DOI: 10.17235/reed.2022.9423/2022

Carta

New technique for the endoscopic removal of long foreign bodies

DOI: 10.17235/reed.2023.9398/2022

Imagen en Patología Digestiva

Whipple’s disease – A typical endoscopic finding of a rare disease

DOI: 10.17235/reed.2022.9338/2022

Imagen en Patología Digestiva

A rare endoscopic pattern in a patient with gastroesophageal reflux disease

DOI: 10.17235/reed.2022.9124/2022

Imagen en Patología Digestiva

Esophageal tuberculosis

DOI: 10.17235/reed.2022.9108/2022

Imagen en Patología Digestiva

Esophagopleural fistula due to empyema necessitans

DOI: 10.17235/reed.2022.9085/2022

Imagen en Patología Digestiva

Pneumatosis intestinalis: a rare endoscopic feature of colonic ischemia

DOI: 10.17235/reed.2022.8980/2022

Carta

¿Melanoma intestinal primario?

DOI: 10.17235/reed.2022.8944/2022

Carta

Amiloidosis intestinal: un reto diagnóstico

DOI: 10.17235/reed.2022.8934/2022

Carta

Íleo biliar resuelto por endoscopia

DOI: 10.17235/reed.2022.8898/2022

Carta

Digestive tract MALT lymphoma, an unusual location

DOI: 10.17235/reed.2022.8800/2022

Imagen en Patología Digestiva

Metaplasia epidermoide de esófago: una entidad infrecuente

DOI: 10.17235/reed.2022.8708/2022

Imagen en Patología Digestiva

Tumor neuroendocrino ileal como causa infrecuente de hemorragia digestiva de origen oscuro

DOI: 10.17235/reed.2022.8641/2022

Imagen en Patología Digestiva

A case of duodenal-type follicular lymphoma

DOI: 10.17235/reed.2021.8233/2021

Imagen en Patología Digestiva

Endoscopic resection of a duodenal neuroendocrine tumor

DOI: 10.17235/reed.2021.8232/2021

Imagen en Patología Digestiva

Duodenal-type follicular lymphoma: a silent tumor

DOI: 10.17235/reed.2021.8149/2021

Imagen en Patología Digestiva

Neumatosis intestinal idiopática o primaria: un hallazgo casual endoscópico poco frecuente

DOI: 10.17235/reed.2021.8049/2021

Carta

Bochdalek hernia: use of capsule endoscopy

DOI: 10.17235/reed.2021.7760/2020

Imagen en Patología Digestiva

Endoscopic forceps removal for complicated magnetic beads impaction

DOI: 10.17235/reed.2021.7731/2020

Imagen en Patología Digestiva

Afectación ampollosa esofágica por pénfigo vulgar

DOI: 10.17235/reed.2020.7417/2020

Revisión

Advanced therapy by device-assisted enteroscopy

DOI: 10.17235/reed.2020.6971/2020

Carta

Luetic gastritis: an uncommon cause of gastritis

DOI: 10.17235/reed.2020.6870/2020

Carta

Úlcera gástrica por mucormicosis en paciente crítico

DOI: 10.17235/reed.2020.6636/2019

Carta

Esophagogastroduodenoscopy: how far should we go? Point of view

DOI: 10.17235/reed.2019.6585/2019

Carta

Coriocarcinoma gástrico primario

DOI: 10.17235/reed.2020.6478/2019

Imagen en Patología Digestiva

Jejunal schwannoma detected by video capsule endoscopy

DOI: 10.17235/reed.2020.6474/2019

Imagen en Patología Digestiva

Capsule endoscopy, a useful tool for the diagnosis of a tapeworm infection

DOI: 10.17235/reed.2019.6346/2019

Editorial

Unidades de endoscopia, statu quo

DOI: 10.17235/reed.2019.6347/2019

Carta

Mastocitosis sistémica diagnosticada endoscópicamente

DOI: 10.17235/reed.2019.6246/2019

Imagen en Patología Digestiva

A rare heterotopic gastric mucosa appearing between the muscularis mucosae and submucosa

DOI: 10.17235/reed.2019.6134/2018

Artículo Especial

Indicadores de calidad en gastroscopia. Procedimiento de la gastroscopia

DOI: 10.17235/reed.2019.6023/2018

Carta

Manejo endoscópico del síndrome de Boerhaave

DOI: 10.17235/reed.2019.6013/2018

Imagen en Patología Digestiva

Neoplasia papilar mucinosa intraductal de conducto principal en un paciente con páncreas divisum

DOI: 10.17235/reed.2019.5959/2018

Carta

Use of patency capsule in daily practice

DOI: 10.17235/reed.2019.5952/2018

Carta

Symptomatic exfoliative esophagitis induced by dabigatran

DOI: 10.17235/reed.2018.5747/2018

Artículo Especial

Endoscopia y sedación: un binomio inseparable para el gastroenterólogo

DOI: 10.17235/reed.2018.5585/2018

Carta al Editor

Me, the intruder: revisited and rethought

DOI: 10.17235/reed.2018.5575/2018

Imagen en Patología Digestiva

Dysphagia and hematemesis caused by an intramural esophageal dissection

DOI: 10.17235/reed.2018.5471/2018

Imagen en Patología Digestiva

Metástasis de dermatofibrosarcoma diagnosticada mediante cápsula endoscópica

DOI: 10.17235/reed.2018.4900/2017

Carta al Editor

Retención sintomática de cápsula degradable Agile®

DOI: 10.17235/reed.2017.4691/2016

Carta al Editor

Ball valve syndrome caused by a giant gastric Vanek’s tumor

DOI: 10.17235/reed.2017.4526/2016

Original

Estudio multicéntrico de seguridad en endoscopia bariátrica

DOI: 10.17235/reed.2017.4499/2016

Carta al Editor

Extracción endoscópica de paquete de hachís

DOI: 10.17235/reed.2017.4504/2016

Carta al Editor

Whipple’s disease under the vision of capsule endoscopy

DOI: 10.17235/reed.2016.4362/2016

Carta al Editor

About human taeniasis and Taenia saginata diagnosis by endoscopy

DOI: 10.17235/reed.2016.4297/2016

Imagen en Patología Digestiva

Jejunal metastasis of renal cell carcinoma

Carta al Editor

Resección endoscópica submucosa transanal (TASER) mediante sistema TEO

DOI: 10.17235/reed.2016.4154/2015

Caso Clínico

Diagnóstico atípico mediante cápsula endoscópica: enfermedad de Whipple

DOI: 10.17235/reed.2015.3718/2015

Instrucciones para citar
Pérez-Cuadrado Robles E, González Ramírez A, Lancho Seco Á, Martí Marqués E, Dacal Rivas A, Castro Ortiz E, et all. Safety and risk factors for difficult endoscopist-directed ERCP sedation in daily practice: a hospital-based case-control study. 4206/2016


Descargar en un gestor de citas

Descargue la cita de este artículo haciendo clic en uno de los siguientes gestores de citas:

Métrica
Este artículo ha sido visitado 841 veces.
Este artículo ha sido descargado 187 veces.

Estadísticas de Dimensions


Estadísticas de Plum Analytics

Ficha Técnica

Recibido: 18/01/2016

Aceptado: 14/02/2016

Prepublicado: 25/02/2016

Publicado: 29/04/2016

Tiempo de revisión del artículo: 19 días

Tiempo de prepublicación: 38 días

Tiempo de edición del artículo: 102 días


Compartir
Este artículo ha sido valorado por 1 lectores .
Valoración del lector:
Valora este artículo:




Asociación Española de Ecografía Digestiva Sociedad Española de Endoscopia Digestiva Sociedad Española de Patología Digestiva
La REED es el órgano oficial de la Sociedad Española de Patología Digestiva, la SociedadEspañola de Endoscopia Digestiva y la Asociación Española de Ecografía Digestiva
Política de cookies Política de Privacidad Aviso Legal © Copyright 2023 y Creative Commons. Revista Española de Enfermedades Digestivas