Postoperative Complications Associated with Moderate Sedation in Endoscopic Procedures Among Patients with Cirrhosis

2018 ◽

Vol 2018 ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

Deepak Agrawal ◽

Rajeev Jain

Keyword(s):

United States ◽

Patient Care ◽

Response Rate ◽

The United States ◽

Survey Study ◽

Moderate Sedation ◽

Endoscopic Procedures ◽

Staffing Patterns ◽

And Training

Background. Endoscopy nurse (RN) has a pivotal role in administration and monitoring of moderate sedation during endoscopic procedures. When sedation for the procedure is administered and monitored by an anesthesia specialist, the role of an RN is less clear. The guidelines on this issue by nursing and gastroenterology societies are contradictory. Methods. Survey study of endoscopy lab managers and directors at outpatient endoscopy units in Texas. The questions related to staffing patterns for outpatient endoscopies and responsibilities of different personnel assisting with endoscopies. Results. Responses were received from 65 endoscopy units (response rate 38%). 63/65 (97%) performed at least a few cases with an anesthesia specialist. Of these, 49/63 (78%) involved only an endoscopy technician, without an additional RN in the room. At 12/49 (25%) units, the RN performed tasks of an endoscopy technician. At 14/63 (22%), an additional RN was present during endoscopic procedures and performed tasks not directly related to patient care. Conclusions. Many ambulatory endoscopy units do not have an RN present at all times when sedation is administered by an anesthesia specialist. An RN, when present, did not perform tasks commensurate with the education and training. This has implications about optimal utilization of nurses and cost of performing endoscopies.

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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 ◽

10.1055/a-1197-6762 ◽

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.

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Iatrogenic injury of duodenum: malady of a therapeutic misadventure

BMJ Case Reports ◽

10.1136/bcr-2021-242294 ◽

2021 ◽

Vol 14 (4) ◽

pp. e242294

Author(s):

Swastik Mishra ◽

Pankaj Kumar ◽

Prakash Kumar Sasmal ◽

Tushar Subhadarshan Mishra

Keyword(s):

Duodenal Ulcer ◽

Postoperative Complications ◽

Surgical Management ◽

Surgical Intervention ◽

Gastroduodenal Artery ◽

Duodenal Stump ◽

Duodenal Injury ◽

Acute Bleeding ◽

Endoscopic Procedures ◽

Bleeding Duodenal Ulcer

Endoscopic procedures are the front-runner of the management of bleeding duodenal ulcer. Rarely, surgical intervention is sought for acute bleeding, not amenable to endoscopic procedures. Oversewing of the gastroduodenal artery at ulcer crater by transduodenal approach is the most acceptable and recommended method of treatment. We describe a case of an intraoperative duodenal injury that occurred during an attempt to oversew the gastroduodenal artery after a duodenotomy, leading to an unsatisfactory and meagre duodenal stump. This case will highlight the intraoperative turmoil, postoperative complications and management of a series of anticipated but unfortunate events that have rendered us wiser in terms of surgical management of a bleeding duodenal ulcer.

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Supplemental Oxygen During Moderate Sedation and the Occurrence of Clinically Significant Desaturation During Endoscopic Procedures

Gastroenterology Nursing ◽

10.1097/01.sga.0000334034.94370.bf ◽

2008 ◽

Vol 31 (4) ◽

pp. 281-285 ◽

Cited By ~ 26

Author(s):

Lorraine Rozario ◽

Donna Sloper ◽

Michael J. Sheridan

Keyword(s):

Supplemental Oxygen ◽

Moderate Sedation ◽

Endoscopic Procedures ◽

Clinically Significant

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Patient characteristics and procedural outcomes of moderate sedation for endoscopic procedures in patients with obesity: A retrospective, propensity score-matched study

Endoscopy International Open ◽

10.1055/a-1555-2762 ◽

2021 ◽

Vol 09 (11) ◽

pp. E1674-E1679

Author(s):

Shashank Garg ◽

Shorabuddin Syed ◽

Abhilash Perisetti ◽

Sumant Inamdar ◽

John Vargo

Keyword(s):

Propensity Score ◽

Propensity Score Matching ◽

Recovery Time ◽

Patient Characteristics ◽

Obese Patients ◽

Withdrawal Time ◽

Moderate Sedation ◽

Endoscopic Procedures ◽

Matched Study ◽

Procedural Outcomes

Abstract Background Endoscopic procedures are performed commonly with moderate sedation. Obesity can pose a challenge in its safe administration. This study was aimed at assessing outcomes of endoscopy procedures performed with moderate sedation in obese patients. Patients and methods This was a retrospective study of patients undergoing esophagogastroduodenoscopy (EGD) and/or colonoscopy with moderate sedation from July 17, 2017 to December 31, 2019. Demographics, comorbidities, outpatient medications and procedure-related outcomes (procedure time, recovery time, cardiopulmonary adverse events, 7-day post-procedure hospitalization, cecal intubation time, withdrawal time, tolerance of moderate sedation and sedation medications administered) were compared for patient with and without obesity after propensity score matching. Standard statistical methods were used for analysis. Results A total of 7601 procedures were performed with moderate sedation for 5746 patients. Propensity score matching identified 1360 and 1740 pairs of EGDs and colonoscopies with moderate sedation for patients with and without obesity. Recovery time was found to be shorter for obese patients undergoing EGD (OR: 0.989, 95 % CI: 0.981–.998; P = 0.01). Obese patients did not differ from non-obese patients in any other procedure-related outcomes for EGDs or colonoscopies. Conclusions Outcomes for endoscopy procedures performed with moderate sedation were noted to be similar between obese and non-obese patients. These findings suggest that moderate sedation can be used safely for endoscopic procedures in patients with obesity.

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A systematic review and meta-analysis of randomized, controlled trials of moderate sedation for routine endoscopic procedures

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2007.12.046 ◽

2008 ◽

Vol 67 (6) ◽

pp. 910-923 ◽

Cited By ~ 268

Author(s):

Kenneth R. McQuaid ◽

Loren Laine

Keyword(s):

Systematic Review ◽

Randomized Controlled Trials ◽

Meta Analysis ◽

Controlled Trials ◽

Moderate Sedation ◽

Endoscopic Procedures ◽

Randomized Controlled

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Safety and Efficacy of 3 Pediatric Midazolam Moderate Sedation Regimens

Anesthesia Progress ◽

10.2344/anpr-64-02-04 ◽

2017 ◽

Vol 64 (2) ◽

pp. 66-72 ◽

Cited By ~ 2

Author(s):

Rachel Gentz ◽

Paul Casamassimo ◽

Homa Amini ◽

Dan Claman ◽

Megann Smiley

Keyword(s):

Side Effects ◽

Postoperative Complications ◽

Physical Examination ◽

Medical History ◽

Moderate Sedation ◽

Safety And Efficacy ◽

Physical Assessment ◽

Oral Midazolam ◽

Trained Staff

Our aim was to characterize effectiveness and complications in children receiving oral midazolam alone, nasal midazolam alone, or oral midazolam with other sedatives. Children received oral midazolam alone, nasal midazolam, or oral midazolam in combination with other sedative medications. All subjects received a presedation history and physical examination and were sedated per protocol by any of 28 resident providers under attending supervision. Sedations were rated for success and complications by clinicians. Postoperative complications were assessed by trained staff up to 48 hours postoperatively. Seven hundred and one encounters, completed over 24 months, yielded 650 usable sedations. The majority of children were healthy (469; 68.2%) and 86% (532) weighed between 10 and 25 kg. Sedations were deemed successful in about 80% of cases. Planned treatment was completed in over 85% of encounters. Oral midazolam alone yielded the best behavior. Physical assessment factors of behavior and age were correlated (P = .035) with effectiveness. Hiccups and a positive medical history were significantly related (P = .049). Side effects of either nausea/vomiting, dysphoria, or hiccups occurred in less than 10% of cases. All 3 regimens were effective with minimal postoperative complications.

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