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Monitoring of blood pressure and heart rate during routine endoscopy: a prospective, randomized, controlled study
J A DiSario1, J P Waring, G Talbert
1Gastroenterology Section, Carl T. Hayden VA Medical Center, Phoenix, Arizona.
Insights
Automated cardiovascular monitoring during endoscopy revealed frequent, clinically insignificant hemodynamic changes. Routine monitoring in this setting does not improve patient outcomes.
Area of Science:
- Cardiology
- Gastroenterology
- Medical Devices
Background:
- Routine endoscopy involves monitoring patients for adverse events.
- Hemodynamic parameters can fluctuate during endoscopic procedures.
Purpose of the Study:
- To compare automated cardiovascular monitoring with clinical observation during routine endoscopy.
- To assess the clinical significance of hemodynamic aberrations detected by automated monitoring.
Main Methods:
- Randomized 618 patients to automated monitoring or clinical observation.
- Recorded hemodynamic parameters (heart rate, blood pressure) at 3-minute intervals before, during, and after endoscopy.
- Analyzed correlations between hemodynamic changes and patient factors or procedure duration.
Main Results:
- Automated monitoring detected frequent hemodynamic aberrations (71%), including hypotension, hypertension, bradycardia, and tachycardia.
- Upper endoscopy increased heart rate; colonoscopy decreased blood pressure and heart rate.
- Despite frequent aberrations, no adverse outcomes occurred in monitored or control patients.
- Hypotensive episodes were often unrecognized, and interventions did not improve outcomes.
- Hemodynamic changes correlated with baseline parameters, coronary artery disease, medications, and procedure length.
Conclusions:
- Automated cardiovascular monitoring during routine endoscopy unmasks frequent, clinically insignificant hemodynamic aberrations.
- Routine monitoring does not improve patient outcomes in this context.
Abstract:
Six hundred and eighteen patients were randomized to have automated cardiovascular monitoring or clinical observation during routine endoscopy. Hemodynamic parameters were recorded at 3-min intervals before, during, and after the procedure. Upper gastrointestinal endoscopy resulted in an increased heart rate (HR), while colonoscopy caused a decreased blood pressure (BP) and HR. Hemodynamic aberrations occurred in 71% of monitored patients, including hypotension 6%, hypertension 30%, bradycardia 26%, and tachycardia 32%. Only one-third of the hypotensive episodes were recognized as aberrations, and therapeutic intervention did not improve outcome. No monitored or control patient had an adverse result. Certain hemodynamic changes were directly correlated with the baseline BP or HR and associated with the presence of coronary artery disease, particular medicines with cardiovascular effects and longer procedure duration. We conclude that automated monitoring during routine endoscopy unmasks frequent hemodynamic aberrations that are clinically insignificant. Routine monitoring during endoscopy does not improve outcome.