Risk factors for sedation-related adverse events during endoscopic ultrasound

Complex endoscopic procedures such as endoscopic ultrasound (EUS) require higher doses of sedation, and thus carry a higher risk of adverse events compared to conventional endoscopy. This prospective cohort study assessed the safety of propofol sedation administered by non-anesthesiologists, and identified factors associated with sedation-related adverse events during EUS.

A total of 2986 examinations were performed between January 2011 and May 2019. We collected data on patient characteristics (including age, body mass index and American Society of Anesthesiologists [ASA] class), procedural details, and sedation-related outcomes. Procedure characteristics and sedation-related adverse events were compared, firstly between interventional and diagnostic EUS, and then based on body mass index, ASA class and age. Logistic regression was performed to search for independent risk factors for sedation-related adverse events.

Sedation-related complications occurred in 4.8% of patients, hypoxemia being the most frequent (3.8%). Obese patients exhibited the highest rates of hypoxemia, early discontinuation and bag-mask ventilation (29.6%, 22.2% and 11.1%, respectively). Multivariate analysis revealed that obesity (odds ratio [OR] 8.57, 95% confidence interval [CI] 3.62-20.28) and comorbidities (ASA III/IV) (OR 2.04, 95%CI 1.44-3.01) were independently associated with sedation-related adverse events, while age was not significant.

Propofol sedation administered by non-anesthesiologists during EUS was safe, with low rates of adverse events, the vast majority of which were clinically insignificant. Comorbidities and obesity, but not age, were independent risk factors for sedation-related complications during EUS. Appropriate patient selection and adequate training of endoscopists are warranted to minimize the risks associated with sedation during EUS.