Risk factors for cardiopulmonary events during propofol-mediated upper endoscopy and colonoscopy

Area of Science:

• Medical research
• Gastroenterology
• Anesthesiology

Background:

• Propofol is widely used for sedation during endoscopic procedures due to its fast action and recovery.
• However, potential cardiopulmonary events associated with propofol sedation require careful evaluation.

Purpose of the Study:

• To investigate the occurrence and risk factors of cardiopulmonary events during propofol-sedated upper endoscopy (EGD) and colonoscopy.
• To identify procedure-specific risks and patient characteristics influencing these events.

Main Methods:

• A large cohort study utilizing the Clinical Outcomes Research Initiative database.
• Involved 69 practice sites and 593 US endoscopists, analyzing data from 5928 EGDs and 11,683 colonoscopies.
• Multivariate logistic regression was employed to assess risk factors, including age, ASA classification, and sedation method (monitored anesthesia care vs. gastroenterologist-administered).

Main Results:

• The overall cardiopulmonary event rate was 11.7 per 1000 cases.
• Higher ASA classification correlated with increased risk in colonoscopy.
• Monitored anesthesia care was linked to a reduced risk (RR 0.5) overall, particularly in ASA I and II patients undergoing EGD (ARR 0.29).
• No significant risk difference was observed between sedation methods for ASA class III or greater patients.

Conclusions:

• Cardiopulmonary event risks during propofol-sedated endoscopy are procedure-specific.
• Patient factors like ASA classification and the method of anesthesia administration influence these risks.
• Findings should inform future research and clinical practice for safer endoscopic sedation.