Conscious Sedation for Endoscopic Procedure: A Systematic Review

Archives of Anesthesia and Critical Care ◽

10.18502/aacc.v7i2.6302 ◽

2021 ◽

Author(s):

Zahid Hussain Khan ◽

Fadhaa Shnan Al-fadhili

Keyword(s):

Conscious Sedation ◽

Turnaround Time ◽

Day Surgery ◽

Cardiovascular Complications ◽

Endoscopic Procedure ◽

Anesthetic Technique ◽

Morbidity Rate ◽

Anesthetic Techniques ◽

Endoscopic Procedures ◽

Hand Search

Background: Sedation has a beneficial impact on patient’s tolerance to the endoscopic procedure. Conscious sedation is the anesthetic techniques of choice for endoscopic procedure. Conscious sedation for endoscopic procedure could be with one drug or a combination of drugs. There have been broad variations in sedation procedure between different countries, and even between different units within the same country. All drugs which depress the central nervous system have the ability to produce respiratory or cardiovascular complications. Endoscopy has a recorded mortality of 1 in 2000 and a morbidity rate of 1 in 200. These sedation techniques have their effects on patients. The main goal of this study is to describe the effects of conscious sedation on patients' outcome for endoscopic procedure. Methods: The design for this study was a review of literature in the medical databases of PubMed, Scopus, Embase, Cochrane and hand search journals from conferences in English. All studies that evaluated the use of CS for endoscopic procedure were included. Results: The results showed that the pain level of the patient (visual analogue scale) was substantially positive when conscious sedation was used. Conscious sedation, however is a lightly sedated patient who is conscious, amnesic, co-operative on demand and free from fear and anxiety. It is often used during endoscopic procedures to minimize discomfort and relax the patients. The intraoperative hypotension has also been extreme in some medications relative to others. Conclusion: The study revealed that CS is reliable and well tolerated anesthetic technique for endoscopic procedures, and is a better option for elective endoscopic procedures CS benefits for endoscopisit and patient outcome is superior to GA such as; short recovery times, less analgesia requirement, comfortable for patient which in turn, leads to faster induction, faster endoscopy, faster discharge, and faster turnaround time. Patients are usually willing to go home after a couple of hours. Rapid recovery is a benefit not only for patients, but also for hospital and day surgery departments. This increases the overall performance of the endoscopy unit.

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Respiratory Complications in Outpatient Endoscopy with Endoscopist-Directed Sedation

Journal of Gastrointestinal and Liver Diseases ◽

10.15403/jgld.2014.1121.233.kf1 ◽

2014 ◽

Vol 23 (3) ◽

pp. 255-259 ◽

Cited By ~ 11

Author(s):

Kilian Friedrich ◽

Sabine G. Scholl ◽

Sebastian Beck ◽

Daniel Gotthardt ◽

Wolfgang Stremmel ◽

...

Keyword(s):

Antibiotic Treatment ◽

Respiratory Infection ◽

Endoscopic Procedure ◽

Shortness Of Breath ◽

Respiratory Complications ◽

Endoscopic Procedures ◽

Increased Risk ◽

High Incidence ◽

Respiratory Complaints

Background & Aims: Respiratory complications represent an important adverse event of endoscopic procedures. We screened for respiratory complications after endoscopic procedures using a questionnaire and followed-up patients suggestive of respiratory infection.Method: In this prospective observational, multicenter study performed in Outpatient practices of gastroenterology we investigated 15,690 patients by questionnaires administered 24 hours after the endoscopic procedure.Results: 832 of the 15,690 patients stated at least one respiratory symptom after the endoscopic procedure: 829 patients reported coughing (5.28%), 23 fever (0.15%) and 116 shortness of breath (SOB, 0.74%); 130 of the 832 patients showed at least two concomitant respiratory symptoms (107 coughing + SOB, 17 coughing + fever, 6 coughing + coexisting fever + SOB) and 126 patients were followed-up to assess their respiratory complaints. Twenty-nine patients (follow-up: 22.31%, whole sample: 0.18%) reported signs of clinically evident respiratory infection and 15 patients (follow-up: 11.54%; whole sample: 0.1%) received therefore antibiotic treatment. Coughing or vomiting during the endoscopic procedure resulted in a 156.12-fold increased risk of respiratory complications (95% CI: 67.44 - 361.40) and 520.87-fold increased risk of requiring antibiotic treatment (95% CI: 178.01 - 1524.05). All patients of the follow-up sample who coughed or vomited during endoscopy developed clinically evident signs of respiratory infection and required antibiotic treatment while this occurred in a significantly lower proportion of patients without these symptoms (17.1% and 5.1%, respectively).Conclusions: We demonstrated that respiratory complications following endoscopic sedation are of comparably high incidence and we identified major predictors of aspiration pneumonia which could influence future surveillance strategies after endoscopic procedures.

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Digital Recording and Documentation of Endoscopic Procedures: Do Patients and Doctors Think Alike?

Canadian Journal of Gastroenterology and Hepatology ◽

10.1155/2016/2493470 ◽

2016 ◽

Vol 2016 ◽

pp. 1-7 ◽

Cited By ~ 2

Author(s):

Nadav Willner ◽

Maya Peled-Raz ◽

Dan Shteinberg ◽

Michal Shteinberg ◽

Dean Keren ◽

...

Keyword(s):

Endoscopic Procedure ◽

Survey Study ◽

Digital Recording ◽

Background Factors ◽

Endoscopic Procedures ◽

Endoscopy Unit ◽

Number Of Patients ◽

Digital Documentation

Aims and Methods.Conducting a survey study of a large number of patients and gastroenterologists aimed at identifying relevant predictors of interest in digital recording and documentation (DRD) of endoscopic procedures. Outpatients presenting to the endoscopy unit at our institution for an endoscopy examination were anonymously surveyed, regarding their views and opinions of a possible recording of the procedure. A parallel survey for gastroenterologists was conducted.Results.417 patients and 62 gastroenterologists participated in two parallel surveys regarding DRD of endoscopic procedures. 66.4% of the patients expressed interest in digital documentation of their endoscopic procedure, with 90.5% of them requesting a copy. 43.6% of the physicians supported digital recording while 27.4% opposed it, with 48.4% opposing to making a copy of the recording available to the patient. No sociodemographic or background factors predicted patient’s interest in DRD. 66% of the physicians reported having recording facilities in their institutions, but only 43.6% of them stated performing recording. Having institutional guidelines for DRD was found to be the only significant predictor for routine recording.Conclusions.Our study exposes patients’ positive views of digital recording and documentation of endoscopic procedures. In contrast, physicians appear to be much more reluctant towards DRD and are centrally motivated by legal concerns when opposing DRD, as well as when supporting it.

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Spinal versus general anesthesia for patients undergoing outpatient total knee arthroplasty: a national propensity matched analysis of early postoperative outcomes

BMC Anesthesiology ◽

10.1186/s12871-021-01442-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Mark C. Kendall ◽

Alexander D. Cohen ◽

Stephanie Principe-Marrero ◽

Peter Sidhom ◽

Patricia Apruzzese ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Adverse Events ◽

General Anesthesia ◽

Knee Arthroplasty ◽

Anesthetic Management ◽

Anesthetic Technique ◽

Anesthetic Techniques ◽

Short Term ◽

Knee Replacements ◽

Total Knee

Abstract Background A comparison of different anesthetic techniques to evaluate short term outcomes has yet to be performed for patients undergoing outpatient knee replacements. The aim of this investigation was to compare short term outcomes of spinal (SA) versus general anesthesia (GA) in patients undergoing outpatient total knee replacements. Methods The ACS NSQIP datasets were queried to extract patients who underwent primary, elective, unilateral total knee arthroplasty (TKA) between 2005 and 2018 performed as an outpatient procedure. The primary outcome was a composite score of serious adverse events (SAE). The primary independent variable was the type of anesthesia (e.g., general vs. spinal). Results A total of 353,970 patients who underwent TKA procedures were identified comprising of 6,339 primary, elective outpatient TKA procedures. Of these, 2,034 patients received GA and 3,540 received SA. A cohort of 1,962 patients who underwent outpatient TKA under GA were propensity matched for covariates with patients who underwent outpatient TKA under SA. SAE rates at 72 h after surgery were not greater in patients receiving GA compared to SA (0.92%, 0.66%, P = 0.369). In contrast, minor adverse events were greater in the GA group compared to SA (2.09%, 0.51%), P < 0.001. The rate of postoperative transfusion was greater in the patients receiving GA. Conclusions The type of anesthetic technique, general or spinal anesthesia does not alter short term SAEs, readmissions and failure to rescue in patients undergoing outpatient TKR surgery. Recognizing the benefits of SA tailored to the anesthetic management may maximize the clinical benefits in this patient population.

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Anesthetic Choice for Functional Endoscopic Sinus Surgery

American Journal of Rhinology ◽

10.2500/105065892781976745 ◽

1992 ◽

Vol 6 (1) ◽

pp. 1-4 ◽

Cited By ~ 3

Author(s):

John A. Fornadley ◽

Kevin S. Kennedy ◽

Joseph F. Wilson ◽

Peter T. Galantich ◽

Gregg S. Parker

Keyword(s):

General Anesthesia ◽

Endoscopic Sinus Surgery ◽

Functional Endoscopic Sinus Surgery ◽

Sinus Surgery ◽

Patient Comfort ◽

Anesthetic Technique ◽

Anesthetic Techniques ◽

Local Infiltration ◽

Local Technique ◽

Local Anesthetic Injection

Controversy continues concerning the optimal anesthetic technique when completing endoscopic sinus surgery. To attempt to investigate the results using different anesthetic techniques, experience with endoscopic sinus surgery over 12 months (233 cases) was retrospectively reviewed. The use of local anesthetic injection with or without regional blocks (specifically ethmoid and greater palatine) was evaluated, as was the choice of general anesthesia versus local technique in a context of blood loss, patient comfort, and complications. Regional block technique appears to add morbidity for little additional benefit. Endoscopic sinus surgery may be performed safely in appropriately selected patients using either general anesthesia or local infiltration with sedation.

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Intraoperative Blood Loss during Induced Abortion: A Comparison of Anesthetics

Anesthesiology Research and Practice ◽

10.1155/2018/4051896 ◽

2018 ◽

Vol 2018 ◽

pp. 1-5

Author(s):

Camille A. Clare ◽

Gabrielle E. Hatton ◽

Neela Shrestha ◽

Michael Girshin ◽

Andre Broumas ◽

...

Keyword(s):

Blood Loss ◽

Retrospective Chart Review ◽

First Trimester ◽

Induced Abortion ◽

Anesthetic Technique ◽

Anesthetic Techniques ◽

Intraoperative Blood Loss ◽

Anesthetic Agents ◽

Dilatation And Curettage ◽

Increased Risk

Objective. To determine whether there is a difference in intraoperative bleeding with inhalational versus noninhalational anesthetic agents for patients undergoing suction dilatation and curettage for first-trimester induced abortion.Methods. This is an IRB-approved retrospective chart review of the electronic medical records of patients undergoing induced abortion at gestational ages between 5 0/7 and 14 0/7 weeks of pregnancy at the New York City Health + Hospitals/Metropolitan. The records of 138 patients who underwent suction dilatation and curettage for induced abortion between June 2012 and June 2014 were reviewed for an association between anesthetic technique and intraoperative hemorrhage. Twenty patients received inhalational anesthetic agents, while 118 received intravenous anesthetics. Blood loss was estimated by the operating gynecologists.Results. The mean intraoperative blood loss for inhalational anesthetics (113.6 ml) was significantly higher than with noninhalational agents (40.2 ml) (p=0.007). Age, body mass index, and gestational age were not statistically different between the groups; the number of methylergonovine doses at induced abortion trended higher with inhalation anesthetics.Conclusions. The difference in blood loss between the two types of anesthetic techniques was statistically significant. These findings may be important for patients with significant anemia or at an increased risk of bleeding, such as those with unrecognized coagulopathies.

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Patient Satisfaction with General versus Local Anesthesia during Carotid Endarterectomy

Journal of Neurological Surgery Part A Central European Neurosurgery ◽

10.1055/s-0039-1688692 ◽

2019 ◽

Vol 80 (05) ◽

pp. 341-344

Author(s):

Jan Mracek ◽

Jakub Kletecka ◽

Irena Holeckova ◽

Jiri Dostal ◽

Jolana Mrackova ◽

...

Keyword(s):

Patient Satisfaction ◽

Carotid Endarterectomy ◽

Local Anesthesia ◽

Postoperative Nausea And Vomiting ◽

Anesthetic Technique ◽

Anesthetic Techniques ◽

Advantages And Disadvantages ◽

Future Preference ◽

Intraoperative Pain ◽

Optimal Approach

Background and Study Aims Both general and local anesthesia are used in our department for carotid endarterectomy (CEA). The decision as to which anesthetic technique to use during surgery is made individually. The aim of our study was to evaluate patient satisfaction and preference with the anesthesia type used. Material and Methods The satisfaction of a group of 205 patients with regard to anesthesia used and their future preferences were evaluated prospectively through a questionnaire. The reasons for dissatisfaction were assessed. Results CEA was performed under general anesthesia (GA) in 159 cases (77.6%) and under local anesthesia (LA) in 46 cases (22.4%). In the GA group, 148 patients (93.1%) were satisfied; 30 patients (65.2%) in the LA group were satisfied (p < 0.0001). The reason for dissatisfaction with GA were postoperative nausea and vomiting (7 patients), postoperative psychological alteration (3), and fear of GA (1). The reasons for dissatisfaction with LA were intraoperative pain (9 patients), intraoperative discomfort and stress (5), and intraoperative breathing problems (2). Of the GA group, 154 (96.9%) patients would prefer GA again, and of the LA group, 28 (60.9%) patients would prefer LA if operated on again (p < 0.0001). Overall, 172 patients (83.9%) would prefer GA in the future, and 33 patients (16.1%) would prefer LA. Conclusion Overall patient satisfaction with CEA performed under both GA and LA is high. Nevertheless, in the GA group, patient satisfaction and future preference were significantly higher. Both GA and LA have advantages and disadvantages for CEA. An optimal approach is to make use of both anesthetic techniques based on their individual indications and patient preference.

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Anesthesia for Gastrointestinal Endoscopic Procedures

10.1093/med/9780190495756.003.0019 ◽

2018 ◽

Author(s):

Lori Kral Barton ◽

Regina Y. Fragneto

Keyword(s):

General Anesthesia ◽

Patient Characteristics ◽

The United States ◽

Anesthetic Techniques ◽

Anesthesia Care ◽

Care Providers ◽

Endoscopic Procedures ◽

Endoscopic Techniques ◽

Sole Agent ◽

Geographic Regions

As the population ages, patients presenting for endoscopic procedures are more likely to have significant comorbidities. In addition, endoscopic procedures of increasing complexity are being performed. While there are significant differences among geographic regions in the United States, anesthesia care providers are providing sedation or general anesthesia for a greater proportion of procedures performed in the endoscopy suite. A variety of drugs and anesthetic techniques have been used successfully. Propofol remains the most commonly used drug when sedation is provided by an anesthesia professional, sometimes as a sole agent and sometimes in combination with other medications. Dexmedetomine and ketamine have also been used successfully. Patient characteristics and the specific needs of the endoscopist based on the procedure being performed will determine the most appropriate anesthetic regimen for each patient. For more complex endoscopic techniques, general anesthesia may be preferred, with some data indicating improved success of the procedure.

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