Incidence of sedation-related complications and risk factors associated with non-anesthesiologist administration of sedation in endoscopic ultrasound (EUS)- prospective study

AIM To investigate the incidence of adverse events related to non-anesthesiologist sedation during EUS and associated risk factors.

METHODS Our prospective study included EUS investigations performed between 11/2018-10/2019 in two Austrian centers (Klagenfurt and St. Pölten). An “experienced” endosonographer has performed at least 225 EUS examinations including 50 interventions. Propofol and Midazolam were used for sedation and administered by specially trained nurses or physicians. Adverse events were defined according to the ESGE recommendations: hypoxemia (oxygen saturation  < 90 %) and hypotonia (systolic blood pressure  < 90 mmHg).

RESULTS 554 (311 Klagenfurt+243 St. Pölten) EUS in 514 patients were analyzed (mean age 63.6 ± 15.7 years, 52.3 % male). Non-anesthesiologist sedation was performed with a combination of Propofol und Midazolam in 95.6 % of cases. The median dose (range) of Propofol and Midazolam were: 160 (20-760) mg and 3 (1-6) mg, respectively. Sedation related complications were observed in 34/554 (6.1 %) of EUS: hypotonia in 24/554 (4.3 %), hypoxemia in 10/554 (1.8 %) and respiratory or hemodynamic instability in 7/554 (1.6 %) of cases. One patient (0.18 %) needed intubation and died in the intensive care unit. The presence of comorbidities and older age were associated with the occurrence of sedation related complications (table).

CONCLUSION Sedation related adverse events were registered in 6.1 % of EUS in our prospective study, but only 1.6 % of cases showed clinically significant impairment. The presence of comorbidities and older age were associated with a higher incidence of hypoxemia and/or hypotonia. These patients should be evaluated more carefully for the need of an anesthesiologist during the procedure.

Tab. 1

Parameter	EUS without complications(n = 520)	EUS with complications(n = 34)	p value
Age (years)	63.3 ± 15.4	65.6 ± 17.4	0.40
Age > 75 years (%)	24.4	41.1	0.04
Male gender (%)	54.6	50	0.73
BMI (kg/m2)	26.3 ± 5.4	27.2 ± 5.6	0.40
Total Propofol dose (mg)	160(20-760)	140(20-440)	0.10
Propofol dose/kg body weight (mg/kg)	2.4 ± 1.4	2.1 ± 1.3	0.17
Midazolam dose per patient (mg)	3(1-6)	3(1-5)	0.24
Interventional EUS (%)	31.8	21.6	0.29
ASA III	25.7	50	0.003
EUS duration (min)	23(3-71)	20(3-60)	0.30
EUS performed by trainees (%)	45.9	55.8	0.34

Publication History

Article published online:
26 May 2020