Published online Apr 16, 2021. doi: 10.4253/wjge.v13.i4.97
Peer-review started: January 6, 2021
First decision: February 11, 2021
Revised: February 19, 2021
Accepted: March 11, 2021
Article in press: March 11, 2021
Published online: April 16, 2021
Moderate (conscious) sedation administered by endoscopists provides adequate sedation and analgesia for the majority of American Society of Anesthesia (ASA) class I and II patients undergoing routine gastrointestinal (GI) endoscopy. Deep sedation and general anesthesia are traditionally reserved for patients at higher risk for sedation-related adverse events.
Currently, there are limited society guidelines and insufficient data to aid endoscopists in the selection of the most appropriate sedation method. Rather, this decision is often based on the endoscopist's personal discretion and prior experience.
The study’s main objective was to identify patient and procedure characteristics that may predict better tolerance with moderate sedation for routine GI endoscopy.
This was a retrospective cohort study utilizing a nationwide, multi-center repository of endoscopic outcomes. Sedation dose requirements for all adult patients undergoing moderate sedation for esophagogastroduodenoscopy (EGD) and colonoscopy were identified from which patients were stratified into one of two groups based on sedation dose needs (low vs high dose). Anthropometric, procedural, and anesthesia-related data were compared between the two sedation groups, and logistic regression analysis was used to identify factors associated with lower sedation requirements.
Among 371102 patients included, 63137 patients were stratified into the low dose sedation group and 307965 patients were stratified into the high dose sedation group. Patients undergoing EGDs vs colonoscopies, procedure performed in the inpatient vs outpatient setting, and those performed in ambulatory surgery centers vs endoscopy suites were associated with lower moderate sedation requirements. On further multivariable analysis, factors predictive of tolerance with lower sedation requirements for both EGDs and colonoscopies included female gender, older age (≥ 50 years old), non-White race, Hispanic descent, lower BMI (≤ 25 kg/m2) and higher ASA class.
We have provided substantive data identifying key demographic and procedure related variables associated with lower sedation requirements during routine GI endoscopy and thereby, improved tolerance with moderate sedation.
While our findings can help to guide appropriate sedation practices during GI endoscopy, future prospective studies are needed to clarify the effects of patient demographic and procedure related variables on opioid and benzodiazepine response in the procedure setting.