Although anesthesia-directed sedation is safe overall, specific risks for adverse anesthesia-related events are identifiable. The use of anesthesia services for endoscopic procedures has increased steadily in the U.S.; it is the dominant method of endoscopic sedation. The popularity of anesthesia-directed sedation (ADS), including with propofol, derives from its ability to provide deeper sedation with less patient discomfort, greater patient and physician satisfaction, rapid sedation onset and recovery, improved efficiency, and, potentially, improved patient safety, especially in sicker patients and complicated cases, such as endoscopic retrograde cholangiopancreatography (ERCP). However, the overall safety of anesthesia services is controversial, as some studies have shown increased complications, such as aspiration pneumonia and colonic perforation. Investigators conducted this retrospective, cross-sectional study of anesthesia-related complications in 428,947 endoscopic procedures performed with ADS, evaluating which patient, facility, and procedural factors might increase the risk for such complications. Included procedures were colonoscopy (51%), esophagogastroduodenoscopy (EGD, 37%), and ERCP (7%). Monitored anesthesia care (MAC) was done in 53.8% and general anesthesia in 36.7% of cases. Overall complications were reported in 4441 cases (1.09%), with serious complications in 0.34%. Serious complications were significantly associated with older patient age, American Society of Anesthesiologists (ASA) class 4/5, EGDs (especially those with longer duration of anesthesia), general anesthesia, longer procedures, and overnight EGDs/colonoscopies. |
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Overall, the use of anesthesia services during endoscopy appears to be safe, but specific factors increase its risk. Some factors are patient related, such as older age and ASA 4/5 status, and some are associated with case complexity, including the use of general anesthesia and longer duration of anesthesia. The association of complications with overnight procedures is interesting, perhaps explained by decreased physician performance overnight or by sicker patients undergoing urgent endoscopic procedures.