Conscious Sedation, Clinically Relevant Complications and Monitoring of Endoscopy: Results of a Nationwide Survey in Switzerland

Abstract

There is no conclusive evidence that electronic monitoring during gastrointestinal endoscopy reduces patient morbidity and mortality. The aim of this nationwide Swiss survey was to assess the impact of monitoring on the outcome for patients. We therefore evaluated the monitoring practice and the rate of sedation-related clinically relevant complications in a country with a low monitoring prevalence, and compared the results with those for a country in which monitoring is widely applied. A questionnaire pertaining to 1990 was mailed to all 173 Swiss gastroenterologists. The response rate was 71.1 %. Data from 115,200 endoscopies performed by 123 gastroenterologists were analysed. Sixty percent of the procedures were performed under sedation. Patient's vital signs were rarely monitored clinically (≤ 25 %). Electronic monitoring was virtually never performed: oximetry was used by 2.5 % and an electrocardiogram by 0.8 %. The overall sedation-related complication rate was 0.10 %, and no deaths occurred. Thus, the morbidity and mortality related to conscious sedation in Switzerland is low, and not higher than it is in countries with a high monitoring level, such as the USA (0.06-0.54 %). We conclude that clinically detectable and relevant complications attributable to conscious sedation are rare even when vital parameters are not monitored routinely. There is need for a prospective study to evaluate the effect of electronic monitoring on the complication rate for average-risk patients undergoing routine gastrointestinal endoscopy.