scholarly journals Implementation of the European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastroenterology and Endoscopy Nurses and Associates (ESGENA) sedation training course in a regular endoscopy unit

Endoscopy ◽  
2020 ◽  
Vol 53 (01) ◽  
pp. 65-71
Author(s):  
Mauro Manno ◽  
Simona Deiana ◽  
Tommaso Gabbani ◽  
Matteo Gazzi ◽  
Alessandro Pignatti ◽  
...  
Keyword(s):  
Adverse Events ◽  
Training Program ◽  
European Society ◽  
Gastrointestinal Endoscopy ◽  
Deep Sedation ◽  
Safe Procedure ◽  
Moderate Sedation ◽  
Endoscopic Procedures ◽  
Endoscopy Unit ◽  
Electronic Reporting

Abstract Background Several scientific societies have endorsed non-anesthesiologist sedation (NAS) during gastrointestinal endoscopy, considering it a safe procedure when administered by adequately trained personnel. This study aimed to evaluate the occurrence of adverse events after implementation of the European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastroenterology and Endoscopy Nurses and Associates (ESGENA) sedation training program. Methods From January 2017 to August 2018, data from all consecutive endoscopic procedures in adults (≥ 18 years) performed at our endoscopy unit were collected using an electronic reporting system. Results All staff (physicians and nurses) completed the ESGE-ESGENA sedation course. In total, 12 132 patients underwent endoscopic procedures, 10 755 (88.6 %) of which were performed in a non-anesthesiological setting. Of these, about 20 % used moderate sedation with midazolam + fentanyl and 80 % used deep sedation with additional propofol. No sentinel, 5 (0.05 %) moderate risk, and 18 (0.17 %) minor risk adverse events occurred, all during moderate or deep sedation, and all managed by endoscopy staff without the need for anesthesiologist assistance. Conclusions After completing the ESGE-ESGENA sedation training program, the rate of adverse events was very low in our institution. The findings support implementation of the program in all digestive endoscopy units and inclusion in the curriculum for physicians and nurses to ensure safe endoscopic procedures.

Retrospective analysis of deep sedation in pediatric population for endoscopic procedures: adverse events and outcomes

2015 ◽  
Vol 2 (4) ◽  
Author(s):  
Berrin Isik ◽  
Volkan Sivgin ◽  
Mustafa Arslan ◽  
Seyfi Kartal ◽  
Yusuf Unal ◽  
...  
Keyword(s):  
Adverse Events ◽  
Retrospective Analysis ◽  
Deep Sedation ◽  
Pediatric Population ◽  
Endoscopic Procedures

scholarly journals Deep sedation using propofol target-controlled infusion for gastrointestinal endoscopic procedures: a retrospective cohort study*

2020 ◽  
Author(s):  
María. E. García Guzzo ◽  
María Sol Fernandez ◽  
Delfina Sánchez Novas ◽  
Sandra S. Salgado ◽  
Sergio A. Terrasa ◽  
...  
Keyword(s):  
Cohort Study ◽  
Adverse Events ◽  
Confidence Interval ◽  
Retrospective Cohort Study ◽  
Odds Ratio ◽  
Retrospective Cohort ◽  
Gastrointestinal Endoscopy ◽  
Oxygen Desaturation ◽  
Endoscopic Procedures ◽  
Target Controlled Infusion

Abstract Background: Propofol sedation is effective for gastrointestinal endoscopic procedures, but its narrow therapeutic window highlights the importance of identifying an optimal administration technique regarding effectiveness and safety. This study aimed to determine the incidence of significant adverse events in adult patients scheduled for gastrointestinal endoscopy under anaesthetist-performed sedation using propofol target-controlled infusion and determine its potentially improved safety over other anaesthetic strategies. Methods: This single-centre, retrospective cohort study took place in a tertiary referral university hospital. Medical records of 823 patients (age >18 years, American Society of Anesthesiologists physical status classification scores I–III) who had undergone elective gastrointestinal endoscopy under propofol target-controlled infusion sedation during September 2018 were reviewed. Outcomes included hypoxia, hypotension, and bradycardia events, requirement of vasoactive drugs, unplanned tracheal intubation or supraglottic device insertion, and need for advanced cardiac life support. Results: The most frequently encountered adverse event was oxygen desaturation <95% with an incidence of 22.35%. Vasoactive drug administration, hypotension, and oxygen desaturation <90% followed, with incidences of 19.2%, 12.64%, and 9.92%, respectively. Only 0.5% of patients required advanced airway management. Multivariate analysis revealed an association between hypotension events, colonoscopic procedures, and propofol doses (odds ratio: 3.08, 95% confidence interval: 1.43 to 6.61; P=0.004 and odds ratio: 1.14, 95% confidence interval: 1.00 to 1.29; P=0.046). A strong dose-effect relationship was found between hypoxia and obesity; patients with body mass index ≥40 were nine times (odds ratio: 10.22, confidence interval: 95% 2.83 to 36.99) more likely to experience oxygen desaturation <90% events. Conclusions: Propofol sedation using target-controlled infusion appears to be a safe and effective anaesthetic technique for gastrointestinal endoscopic procedures with low rates of adverse events and could be more widely adopted in clinical practice.

scholarly journals Deep Sedation using Propofol Target-Controlled Infusion for Gastrointestinal Endoscopic Procedures: A Retrospective Cohort Study*

2020 ◽  
Author(s):  
MARIA EUGENIA GARCIA GUZZO ◽  
María Sol Fernandez ◽  
Delfina Sánchez Novas ◽  
Sandra S. Salgado ◽  
Sergio A. Terrasa ◽  
...  
Keyword(s):  
Cohort Study ◽  
Adverse Events ◽  
Confidence Interval ◽  
Retrospective Cohort Study ◽  
Odds Ratio ◽  
Retrospective Cohort ◽  
Gastrointestinal Endoscopy ◽  
Oxygen Desaturation ◽  
Endoscopic Procedures ◽  
Target Controlled Infusion

Abstract Background: Propofol sedation is effective for gastrointestinal endoscopic procedures, but its narrow therapeutic window highlights the importance of identifying an optimal administration technique regarding effectiveness and safety. This study aimed to determine the incidence of significant adverse events in adult patients scheduled for gastrointestinal endoscopy under anaesthetist-performed sedation using propofol target-controlled infusion and determine its potentially improved safety over other anaesthetic strategies. Methods: This single-centre, retrospective cohort study took place in a tertiary referral university hospital. Medical records of 823 patients (age >18 years, American Society of Anesthesiologists physical status classification scores I–III) who had undergone elective gastrointestinal endoscopy under propofol target-controlled infusion sedation during September 2018 were reviewed. Outcomes included hypoxia, hypotension, and bradycardia events, requirement of vasoactive drugs, unplanned tracheal intubation or supraglottic device insertion, and need for advanced cardiac life support. Results: The most frequently encountered adverse event was oxygen desaturation <95% with an incidence of 22.35%. Vasoactive drug administration, hypotension, and oxygen desaturation <90% followed, with incidences of 19.2%, 12.64%, and 9.92%, respectively. Only 0.5% of patients required advanced airway management. Multivariate analysis revealed an association between hypotension events, colonoscopic procedures, and propofol doses (odds ratio: 3.08, 95% confidence interval: 1.43 to 6.61; P=0.004 and odds ratio: 1.14, 95% confidence interval: 1.00 to 1.29; P=0.046). A strong dose-effect relationship was found between hypoxia and obesity; patients with body mass index ≥40 were nine times (odds ratio: 10.22, confidence interval: 95% 2.83 to 36.99) more likely to experience oxygen desaturation <90% events. Conclusions: Propofol sedation using target-controlled infusion appears to be a safe and effective anaesthetic technique for gastrointestinal endoscopic procedures with low rates of adverse events and could be more widely adopted in clinical practice.

scholarly journals Opportunity Costs of Gastrointestinal Endoscopic Training in Canada

2010 ◽  
Vol 24 (12) ◽  
pp. 733-738 ◽  
Author(s):  
WT Depew ◽  
LC Hookey ◽  
SJ Vanner ◽  
JA Louw ◽  
CE Lowe ◽  
...  
Keyword(s):  
Training Program ◽  
Royal College ◽  
Performance Standards ◽  
Resident Training ◽  
Opportunity Costs ◽  
Academic Hospital ◽  
Negative Effects ◽  
Training Activity ◽  
Endoscopic Procedures ◽  
Endoscopy Unit

BACKGROUND: No data exist to define the opportunity costs related to instruction in endoscopic procedures in Royal College of Physicians and Surgeons of Canada-accredited teaching centres. Academic and institutional administrators expect staff to achieve acceptable performance standards. There is a need to measure some of the effects of training activity in the establishment of such standards.OBJECTIVE: To measure the effect of resident training in colonoscopy on real procedure times and, as a secondary goal, to estimate procedural losses related to the process of training.METHODS: Real procedure times for ambulatory colonoscopy in a single academic, hospital-based endoscopy unit were documented. Times for certified endoscopy instructors functioning solo were compared with times for procedures involving trainees at several levels of colonoscopic experience. Procedural reductions associated with resident training were estimated based on the parameters derived from the results. The analysis was executed retrospectively using prospectively collected data.RESULTS: Resident training prolonged procedure times for ambulatory colonoscopy by 50%. The trainee effect was consistent, although variable in degree, among a variety of endoscopy instructors. Such increased procedure times have the potential to reduce case throughput and endoscopist remuneration.CONCLUSIONS: Resident training in colonoscopy in a Canadian certified training program has significant negative effects on case throughput and endoscopist billings. These factors should be considered in any assessment of performance in similar training environments.

Correction: European Society of Gastrointestinal Endoscopy (ESGE) curricula development for postgraduate training in advanced endoscopic procedures: rationale and methodology

Endoscopy ◽  
2019 ◽  
Vol 51 (10) ◽  
pp. C6-C6
Author(s):  
Raf Bisschops ◽  
Evelien Dekker ◽  
James E. East ◽  
Gavin Johnson ◽  
Pedro Pimentel-Nunes ◽  
...  
Keyword(s):  
European Society ◽  
Gastrointestinal Endoscopy ◽  
Postgraduate Training ◽  
Endoscopic Procedures

scholarly journals A plea for a unified approach to sedation in gastrointestinal endoscopy in Romania: results from a prospective multicentric trial

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Theodor Voiosu ◽  
Tudor Moga ◽  
Cristian Nedelcu ◽  
Cristina Tocia ◽  
Monica State ◽  
...  
Keyword(s):  
Adverse Events ◽  
Gastrointestinal Endoscopy ◽  
Endoscopic Examination ◽  
Endoscopic Procedures ◽  
Related Information ◽  
Drug Regimens ◽  
Adequate Sedation ◽  
Secondary Study ◽  
The Impact ◽  
Procedure Type

Abstract Background: Adequate sedation is a prerequisite for quality endoscopic examination of the digestive tract. We aimed to evaluate the current practices and safety profile of sedation for gastrointestinal endoscopy in Romania and its impact on the technical success of the procedure and procedure-related adverse events. Methods: We conducted a prospective, multicentric, observational study including all patients undergoing digestive endoscopic procedures under various degrees of sedation. We collected data regarding the endoscopic procedure, type and degree of sedation, drug regimens, personnel in charge of sedation, and relevant patient related information. The main study outcome was the rate of sedation-related adverse events; secondary study outcomes included procedure-related adverse events and the impact of sedation on procedure success. Results: 1043 consecutive endoscopic procedures from eight Romanian endoscopy units were included in our study. Sedation regimens were highly variable between participating centers, with 566 (54%) of procedures being performed under sedation provided by an anaesthesiologist. Sedation-related adverse events occurred in 40 cases (3.8%), most of them were mild respiratory and cardiovascular events and all reversed spontaneously. On multivariate analysis, male gender, procedure type (endoscopic ultrasound and endoscopic retrograde cholangiopancreatography) and deep sedation were risk factors for complications. The endoscopy unit, ASA status, age and type of sedative did not influence the complication rate. Conclusion: In conclusion, sedation for endoscopic procedures is generally safe, despite a high variability in sedation practices between centres in Romania. Establishing a national guideline on sedation for gastrointestinal endoscopy will ensure consistent and safe practice for these procedures.

The Sedation Continuum

2018 ◽  
pp. 20-25
Author(s):  
Élise W. van der Jagt
Keyword(s):  
Adverse Events ◽  
General Anesthesia ◽  
Deep Sedation ◽  
Procedural Sedation ◽  
Dynamic Nature ◽  
Moderate Sedation ◽  
Patient Will ◽  
Physiologic Responses

When patients undergo procedural sedation/analgesia, they enter into a sedation continuum. Several levels have been formally defined along this continuum: minimal sedation/anxiolysis, moderate sedation, deep sedation, and at the deepest level, general anesthesia. An additional and somewhat separate level in the sedation continuum is dissociative sedation, which has its own unique characteristics. Given the dynamic nature of the sedation process, a patient will move in and out of these defined levels (as well as intermediate ones) depending on the agents and dosing used, the procedures being performed, and a patient’s own unique characteristics and physiologic responses. At all times, the provider of procedural sedation/analgesia must be able to recognize the sedation levels attained by the patient and be ready to manage any potential adverse events.

scholarly journals European Society of Gastrointestinal Endoscopy (ESGE) curricula development for postgraduate training in advanced endoscopic procedures: rationale and methodology

Endoscopy ◽  
2019 ◽  
Vol 51 (10) ◽  
pp. 976-979 ◽  
Author(s):  
Raf Bisschops ◽  
Evelien Dekker ◽  
James E. East ◽  
Gavin Johnson ◽  
Pedro Pimentel-Nunes ◽  
...  
Keyword(s):  
European Society ◽  
Gastrointestinal Endoscopy ◽  
Postgraduate Training ◽  
Endoscopic Procedures
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