Propofol-based deep sedation for endoscopic ultrasonography in sick patients in Thailand

Background and Aims: In a developing country, endoscopic ultrasonography (EUS) procedure is being performed at increasing rate. However, there is no recent information on deep sedation of this procedure in sick patients. The aim of this study was to evaluate the clinical efficacy of propofol-based deep sedation, and to compare between ASA physical status I-II and III-IV for EUS procedure in a teaching hospital in Thailand.

Patients and methods: We undertook a retrospective review of the sedation service records of patients who underwent EUS procedures from December 2006 and May 2009. All patients were classified into two groups according to ASA physical status. In group C, ASA physical status was I-II, and ASA physical status in group S was III-IV. The primary outcome variable of the study was the successful completion of the procedure. The secondary outcome variables were sedation related complications during and immediately after the procedure.

Results: Sedation was provided for 197 patients. Of these, 156 (M, 71; mean age 56.0±14.4 years) procedures were in group C, and 41 (M, 21; mean age, 69.1±13.9 years) procedures were in group S. There were no significantly differences in gender, weight, procedure time and indication of endoscopy between the two groups. All patients in both groups were concluded with the successful completion of the procedure. The combination of fentanyl, propofol and midazolam was used in both groups. The mean dose of propofol and midazolam in both groups was not significantly different. Mean dose of fentanyl in group S was significantly lower than in group C (p<0.001). Overall adverse event in group C was significantly occurred less common than in group S. Respiratory adverse events were not statistically significantly different in both groups. Hypotension was the most cardiovascular adverse event in the two groups. All complications were easily treated, with no adverse sequelae.

Conclusion: In the setting of the developing country, propofol-based deep sedation for EUS procedure in sick patients by trained anesthetic personnel with appropriate monitoring was relatively safe and effective. Serious adverse events were rare in our population.