Influence of endoscopic experience, comorbidities and patient age on the complications and dose of sedation on endoscopic ultrasound

Aim:

To investigate the influence of endosonographer experience and patient related factors on the complications and dose of sedation by EUS.

Methods:

Our retrospective study included EUS investigations performed between 2015 – 2018. An experienced endosonographer has performed at least 150 EUS examinations including 50 interventions. Sedation related complications were defined as cardiorespiratory instability with oxygen saturation drop below 85% and/or prolonged hypotonia.

Results:

537 EUS were analyzed (37.3% interventional). The median dose of Propofol and Midazolam were: 140 (30 – 570)mg and 3 (0 – 7)mg, respectively. Sedation related complications were documented in 1.8% of cases. All patients had a transient, non fatal respiratory insufficiency. 60% of the patients who developed complications were> 75 years. Cardiac and/or pulmonary comorbities were present in 80% of patients with complications. The endosonographer experience did not influenced the complications rate (50% vs. 50%).

The Propofol and Midazolam dose was significantly higher in interventional vs. diagnostic EUS: 200 (30 – 570)mg vs. 120 (30 – 540)mg, p < 0.0001 and respectively 3 (0 – 7)mg vs. 2 (0 – 7)mg, p = 0.0007. In both diagnostic and interventional EUS, patients with comorbidities and older age received significant less sedation. Experienced endosonographers used less sedation than trainees (Table).

Tab. 1:

Factors influencing dose of sedation

Factor	EUS-Diagnostic Propofol (mg)	EUS-Intervent. Propofol (mg)	EUS-Diagnostic Midazolam (mg)	EUS-Intervent. Midazolam (mg)
Gender Male (A) Female (B)	A: 120 (30 – 540) B: 120 (30 – 400) p = 0.35	A: 205 (30 – 570) B: 190 (50 – 420) p = 0.12	A: 3 (0 – 7) B: 2 (1 – 5) p = 0.03	A: 3 (0 – 7) B: 3 (0 – 6) p = 0.26
Age (years) < 50 (A) 50 – 75 (B) > 75 (C)	A: 140 (60 – 540) B: 120 (30 – 400) C: 100 (30 – 340) A vs. C: p < 0.0001 B vs. C: p = 0.0001	A: 225 (120 – 420) B: 200 (60 – 570) C: 140 (30 – 380) A vs. C: p = 0.0002 B vs. C: p < 0.0001	A: 3.5 (0 – 5) B: 3 (1 – 7) C: 2 (1 – 5) A vs. C: p < 0.0001 B vs. C: p < 0.0001	A: 5 (2 – 7) B: 3 (0 – 7) C: 2 (0 – 5) A vs. B: p = 0.001 A vs. C: p < 0.0001 B vs. C: p = 0.0008
Comorbidity No (A) Pulmonary (B) Cardiac (C) Pulmonary+Cardiac (D)	A: 120 (30 – 540) B: 100 (40 – 250) C: 100 (30 – 290) D: 90 (50 – 170) A vs. B: 0.04 A vs. C: 0.0006 A vs. D: 0.02	A: 220 (60 – 570) B: 170 (40 – 340) C: 165 (30 – 370) D: 140 (40 – 320) A vs. B: 0.02 A vs. C: 0.001 A vs. D: 0.02	A: 3 (1.5 – 5) B: 2 (0 – 5) C: 2 (1 – 7) D: 2.5 (1 – 5) A vs. B: 0.04 A vs. C: 0.001	A: 3 (0 – 7) B: 3 (0 – 5) C: 3 (2 – 5) D: 2 (2 – 5) A vs. B: p = 0.01 A vs. C: p = 0.007
Endoscopist experience Trainee (A) Experienced (B)	A: 120 (30 – 540) B: 110 (30 – 340) p = 0.005	A: 220 (40 – 570) B: 175 (30 – 420) p = 0.0001	A: 3 (0 – 6) B: 3 (0 – 7) p = 0.20	A: 3 (0 – 7) B: 3 (2 – 7) p = 0.38

Conclusion:

Endosonographer experience, patients age and comorbidities had a significant influence on sedation dose. Sedation-related complications occured only in 1.8% of cases.