Safety and length of different sedations for endoscopic procedures

Introduction

Endoscopic procedures have improved thanks to the fact that they are performed currently under sedation. We describe a series of endoscopic studies, sedated by the Intensive Care Department. Different sedation protocols are described, emphasizing some patients sedated with ketamine plus midazolam, drugs rarely reported for adults.

Methods

Patients older than 18 years, whose performed endoscopic, colonoscopic or both procedures under sedation were performed by the Intensive Care Department of the Hospital del Tajo. Data were collected for 6 months. Demographic characteristics, medical history, American Society of Anesthesiology classification, drugs bolus and total dosages, respiratory and hemodynamic data, the length of procedure and recovery, and complications were collected. Tolerance was assessed by an endoscopist, with a 1 (very bad) to 5 (very good) scale. Different indices of two groups of treatment were compared, propofolfentanyl (Group A) versus ketaminemidazolam (Group B) using the chi-square test and the Student t test.

Results

In total, 245 procedures were included. The procedures were 168 (66.6%) colonoscopies, 34 (13.9%) endoscopies and 43 (17.6%) both procedures together. Tolerance: 33.5% were 5; 58.8% were 4; 4.5% were 3; 0.8% were 2. There were 72 (29.39%) complications, the most common hypotension being 22 (8.98%) and respiratory depression 12 (4.9%). Length of procedure was 31.20 minutes (SD = 15.53) and recovery time was 64.86 minutes (SD = 37.56). Comparing Group A versus Group B, hypotension (12.67% vs. 2.9%, P = 0.023) and respiratory depression (6.67% vs. 0%, P = 0.03) were more frequent with Group A. Group B presented a higher percentage of vomiting (0% vs. 5.8%, P = 0.009) and hallucinations (0% vs. 11.59%, P < 0.001). The length of recovery was longer for Group B (61.12 min vs. 78.98 min, P = 0.008).

Conclusion

Sedation for endoscopic procedures performed by intensivists is safe and well tolerated for most patients, with a similar percentage of complications compared with previous reports. Ketamine plus midazolam are safe and could be useful for short-length sedation in patients with a high risk of respiratory depression.