Characteristics of Reported Adverse Events During Moderate Procedural Sedation: An Update

Many interventional procedures are performed under moderate procedural sedation (MPS). It is important to understand the nature of and factors contributing to adverse events (AEs). Little data exist examining reportable AEs during MPS across specialties. A study was conducted to investigate adverse events during MPS and to compare associated patient and provider characteristics.

In a retrospective review, 83 MPS cases in which safety incidents were reported (out of approximately 20,000 annual cases during a 12-year period at a tertiary medical center) were analyzed. The type of AE and severity of harm were examined using bivariate and multivariate analyses to uncover associations between events with provider, procedure, and patient characteristics.

The most common AEs were oversedation/apnea (60.2%), hypoxemia (42.2%), and aspiration (24.1%). The most common unplanned interventions were the use of reversal agents (55.4%) and prolonged bag-mask ventilation (25.3%). Cardiology, gastroenterology, and radiology were the specialties most frequently associated with AEs. Reversal agents, oversedation, and hypoxemia occurred most frequently in the gastroenterology and cardiology suites. Women were more likely to experience AEs than men, incurring higher rates of hypotension, prolonged bag-mask ventilation, and reversal agents. Increased body mass index was associated with lower rates of hypoxemia, while advanced age correlated with high rates of oversedation, harm done, and use of reversal agents. Malignancy and cardiovascular comorbidities were associated with increased AEs. Patients with respiratory comorbidities were less likely to be subject to AEs.

Certain patient characteristics and types of procedures may be associated with increased risk of AEs during MPS.