Cardiorespiratory complications directly related to endoscopy: associated or not with sedation?

With the advent of routine sedation in digestive endoscopy, specifically the use of propofol, multiple reports have focused on the complications that may potentially emerge because of sedation, and whether administration is safer by anesthetists or trained gastroenterologists. Complications associated with endoscopy itself, whether diagnostic or therapeutic, have also been described. However, the fact that both upper and lower endoscopy per se may be accompanied by complications, both during the procedure or thereafter, is usually overlooked.

Randomized clinical trial to assess the mPADSS scale in recovery and home discharge after endoscopy

BACKGROUND

current clinical practice guidelines recommend the use of objective scales as a criterion for post-endoscopy sedation discharge.

OBJECTIVE

to assess the recovery time, complications and patient satisfaction level using the mPADSS scale.

MATERIAL AND METHODS

demographic data and medical history were collected. Vital signs, anxiety and abdominal pain were measured pre-endoscopy. Patients were randomized into a control group, discharged according to the usual practice, and the intervention group, who underwent the mPADSS scale every ten minutes, until an objective score was reached.

RESULTS

one hundred and eighteen patients were randomized (78 colonoscopies, 32 gastroscopies, three gastro + colonoscopies and 15 endoscopic retrograde cholangiopancreatographies/endoscopic ultrasound [ERCP/USE]). With regard to medical history, there were 36 cases of elevated blood pressure and 19 diabetes cases, 15 with anticoagulant/antiplatelet and 21 with hypnotic/anxiolytic medication. An average of 160 mg of propofol was required per patient, with additional flumazenil and midazolam in 49. There were two episodes of vomiting and three of mild desaturation, all of them in the control group. Sixty patients were included in the control group and 58 in the mPADSS group, who were discharged in 15 and 10 minutes on average respectively (p < 0.005); 24-48h telephone call follow-up data were available for 105 subjects. There were four readmissions (three control and one mPADSS). There were no differences in pain and post-sedation symptoms and the level of satisfaction in terms of attention and duration of stay was similar in both groups.

CONCLUSIONS

this study shows the efficiency, safety and patient satisfaction using the mPADSS scale. Thus, its use is recommend.

Efficacy and safety of intravenous lidocaine in propofol-based sedation for ERCP procedures: a prospective, randomized, double-blinded, controlled trial

BACKGROUND AND AIMS

Propofol-based sedation is widely used in ERCP procedures, but adverse respiratory or cardiovascular events commonly occur. Intravenous injection of lidocaine has an analgesic effect and can reduce the requirements of fentanyl and propofol during abdominal surgery. The objective of this study was to assess the efficacy and safety of intravenous lidocaine on propofol requirements during ERCP procedures.

METHODS

Forty-eight patients scheduled for ERCP were randomly divided into 2 groups, the lidocaine group and the control group. All patients received .02 mg/kg midazolam and .1 μg/kg sufentanil intravenously as premedication. A bolus of propofol was applied for induction of sedation, and perfusion of propofol was applied for maintenance. Patients in the lidocaine group received a bolus of 1.5 mg/kg lidocaine intravenously followed by continuous infusion of 2 mg/kg/h, whereas the control group received the same volumes of saline solution. The primary outcome was the propofol requirement during ERCP.

RESULTS

Compared with the control group, propofol requirements were reduced by 33.8% in the lidocaine group (212.0 ± 118.2 mg vs 320.0 ± 189.6 mg, P = .023). Involuntary movement was less common in the lidocaine group than in the control group (12.5% vs 41.7%, P = .049). In the lidocaine group, postprocedure pain and fatigue, as measured by the visual analog scale, were significantly reduced (0 [range, 0-4] vs 3 [range, 0-5], P = .005; 2 [range, 0-4] vs 5 [range, 2-8], P < .001).The incidence of oxygen desaturation, hypotension, and bradycardia tended to be lower in the lidocaine group.

CONCLUSIONS

Intravenous lidocaine can significantly decrease propofol requirements during ERCP, with higher sedation quality and endoscopist satisfaction. (Clinical trial registration number: NCT03996577.).