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• W2071614793 abstract "There is limited data on efficacy and safety of anesthesia-assisted endoscopy using propofol-mediated sedation in obese individuals undergoing advanced endoscopic procedures (AEP). To study the impact of body mass index (BMI) on frequency of sedation-related adverse events in pts undergoing AEP. Consecutive pts undergoing AEP (ERCP, EUS and deep enteroscopy) at a tertiary referral center were prospectively enrolled. All pts were sedated with propofol +/-benzodiazepines and/or opioids directed by a CRNA supervised by an anesthesiologist. Sedation related complications: 1)airway modifications (AMs) defined as chin lift, nasopharyngeal airway, modified mask airway, bag-mask ventilation, or endotracheal intubation, 2)hypoxemia (SpO2<90%), 3)hypotension requiring vasopressors and 4) early procedure termination. Demographics, Mallampati score, ASA class, pt position (prone/other), response to endoscopic intubation, Aldrete score, propofol dose (per min) were recorded. Pts were categorized into 3 gps (BMI<30,30-35,>35) and incidence of sedation-related complications were compared. Univariate analysis was performed using the Kruskal Wallis and Chi-square test followed by multivariate analysis to identify predictors of sedation-related complications. 1016 pts (mean age: 58 yrs; men: 46.3%, ASA class ≥ 3: 62.2%) were enrolled. Distribution of pts in 3 gps was: BMI<30: 728 (71%), 30-35: 159 (16%) and >35: 127 (13%). There was no difference in the 3 gps for age, ASA class ≥3, Mallampati score, total endoscopy time, position, and total propofol infusion time. BMI <30 group had a higher proportion of pts with no response to endoscopic intubation consistent with at least deep sedation (BMI:<30-90.7%, 30-35-84.1%, >35-85%, p=0.018). There were 203 AMs performed in 141 (13.9%) pts (chin lift 11.1%, modified mask ventilation 4.6%, nasal airway 3.9%, bag mask ventilation 0.3%). Hypoxemia was noted in 7.3%, need for vasopressors in 0.8% and premature termination in 0.6% pts. Increasing BMI was associated with increased frequency of AMs (BMI:<30-10.5%,30-35-18.9%,>35-26.8%, p<0.001) and hypoxemia (BMI:<30-5.3%,30-35-9.4%,>35-13.4%, p=0.004). There was no difference in the frequency of need for vasopressors (BMI:<30-1%,30-35-0.6%,>35-0%, p=0.5) and premature termination of procedures (BMI:<30-0.7%,30-35-0.6%,>35-0%, p=0.6). On multivariate analysis, male sex [OR 3.6 (95% CI 1.3-9.7)] and ASA class ≥3 [OR 6.4 (1.4-29.3)] were independent predictors of sedation related complications. Obesity is associated with an increased frequency of sedation-related adverse events (AMs and hypoxemia). Propofol sedation can be used safely in obese patients undergoing AEP when administered by trained professionals. Future studies should focus on defining risk factors, optimal pre-procedure assessment, and sedation regimen for these patients." @default.
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• W2071614793 date "2011-04-01" @default.
• W2071614793 modified "2023-10-16" @default.
• W2071614793 title "786 Safety of Anesthesia-Assisted Sedation With Propofol for Advanced Endoscopic Procedures in Obese Individuals" @default.
• W2071614793 doi "https://doi.org/10.1016/j.gie.2011.03.116" @default.
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