Z Gastroenterol 2013; 51(6): 568-572
DOI: 10.1055/s-0032-1330441
Originalarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Sedation-Associated Complications in Endoscopy – Prospective Multicentre Survey of 191142 Patients

Sedierungsassoziierte Komplikationen während der Endoskopie – eine prospektive multizentrische Erfassung von 191142 Patienten
T. Frieling
1   Medizinische Klinik II, HELIOS Klinikum Krefeld
,
J. Heise
1   Medizinische Klinik II, HELIOS Klinikum Krefeld
,
C. Kreysel
1   Medizinische Klinik II, HELIOS Klinikum Krefeld
,
R. Kuhlen
2   Board of Management, HELIOS Kliniken GmbH, Berlin
,
M. Schepke
3   Dept. of Gastroenterology and Internal Medicine, HELIOS Klinikum Siegburg
› Institutsangaben
Weitere Informationen

Publikationsverlauf

03. Oktober 2012

03. Dezember 2012

Publikationsdatum:
05. Juni 2013 (online)

Abstract

Background/Aims: Propofol sedation is applied as moderate sedation for almost all diagnostic and interventional endoscopies. Propofol sedation bears the risk of complications such as respiratory as well as cardiopulmonary insufficiency including sedation-induced death. According to recent guidelines, non-anesthesiologist-administered propofol (NAAP) should be performed by an additional person who has NAAP as their sole task.

Methods: In a prospective multicentre survey involving 191,142 patients, clinically relevant endoscopy-associated complications were registered from 02/2010 to 01/2012.

Results: The majority of propofol sedations were applied without additional persons for NAAP. Overall endoscopy-related complication rate was 0.0022 % (n = 424) and sedation-related complications 0.00 042 % (n = 82). Variability over time and between the clinics was low and not influenced by the number of endoscopies performed during the investigation period. Sedation-related death occurred in 6 patients (0.00 003 %), 50 % during emergency endoscopies. In all sedation-associated deaths the patients had ASA class 3 before endoscopy. All fatal complications occurred in the presence of an additional trained person for NAAP.

Conclusion: This large prospective survey shows that propofol sedation in gastrointestinal endoscopy is a safe procedure with a low potential of risk in daily routine. However, high risk patients (ASA ≥ 3) should be identified, especially before emergency endoscopies and managed by additional persons for NAAP and under intensive care surveillance.

Zusammenfassung

Hintergrund/Ziele: Die Propofol-Sedierung wird als moderate Sedierung für die Mehrzahl der diagnostischen und interventionellen Endoskopien verwendet. Die Propofol-Sedierung birgt das Risiko einer respiratorischen bzw. kardiopulmonalen Insuffizienz mit sedierungsinduziertem Tod. Gemäß den aktuellen Leitlinien wird daher für die Propofol-Sedierung eine zusätzliche Person gefordert, die ausschließlich für die Überwachung der Patienten zuständig ist (NAAP).

Methoden: In einer prospektiven multizentrischen Dokumentation wurden von 02/2010 – 01/2012 sedierungsassoziierte Komplikationen bei 191 142 Patienten systematisch erfasst.

Ergebnisse: Die Mehrzahl der Propofol-Sedierungen wurde ohne zusätzliche Person für NAAP durchgeführt. Die gesamten Endoskopie- bzw. die sedierungsassoziierten Komplikationsraten waren 0,0022 % (n = 424) bzw. 0,00 042 % (n = 82). Die Variabilität im Zeitverlauf und zwischen den beteiligten Kliniken war niedrig und nicht von der Anzahl der Endoskopien beeinflusst. Sedierungsassoziierte Todesfälle traten bei 6 Patienten (0,00 003 %) auf, in 50 % während Notfallendoskopien. Alle verstorbenen Patienten zeigten einen deutlich reduzierten Zustand mit ASA 3 vor Endoskopie. Die Endoskopie bei allen Todesfällen wurde in Anwesenheit einer zusätzlichen Person für NAAP durchgeführt.

Schlussfolgerung: Diese große prospektive Erfassung zeigt, dass die Propofol-Sedierung im klinischen Alltag sicher ist und nur ein geringes Risiko aufweist. Allerdings sollten Patienten mit hohem Risiko (ASA ≥ 3), insbesondere vor Notfallendoskopien, identifiziert und durch eine zusätzliche Person für NAAP unter Intensivbedingungen betreut werden.

 
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