Objective: While sedation is integral to modern gastrointestinal endoscopy, it is associated with a risk of cardiorespiratory complications. The primary objective of this study was to prospectively evaluate the safety profile and outcomes of sedation practices for gastrointestinal endoscopy. We aimed to quantify the incidence of specific cardiopulmonary adverse events and to identify the independent patient- and drug-related risk factors associated with these complications. Methods: This prospective, single-center observational study included adult patients undergoing elective gastrointestinal procedures. Pre-procedural demographic and clinical data, including age, body mass index (BMI), American Society of Anesthesiologists score and Mallampati scores, were recorded. Intra-procedural data, including sedative agents, doses, and continuous cardiorespiratory monitoring, were collected. Binomial logistic regression models were used to determine the risk factors for complications. Results: The overall complication rate was 69.6%, with hypotension (58%), hypertension (15%), and hypoxia (12%) being the most frequent adverse events. Multivariate analysis identified increasing age (OR=1.03, p<0.0001), higher BMI (OR=1.06, p=0.004), a Mallampati score of 3 (OR=1.98, p=0.004), and longer procedure duration (OR=1.03, p<0.0001) as independent predictors for any complication. Upper gastrointestinal procedures were associated with an increased risk of hypoxia (OR=2.12, p=0.05). Lidocaine administration at induction markedly reduced the overall complication rate (OR=0.03, p=0.01). Higher maintenance doses of propofol correlated with hypotension (OR=1.003, p=.005), whereas higher induction doses of midazolam increased the risk of hypoxia (OR=1.8, p=0.04) and apnea (OR=2.7, p=0.03). Prior COVID-19 vaccination was a protective factor against postoperative nausea and vomiting (PONV) (OR=0.003, p=0.03). Conclusion: Although sedation for gastrointestinal endoscopy is generally safe, transient cardiorespiratory events are frequent, especially in older or obese patients, those with difficult airways, and during longer procedures. Intravenous lidocaine appeared to be protective against overall complications. Careful pre-procedural assessment, individualized drug selection, and vigilant monitoring are crucial to enhance patient safety. The novel finding of a protective effect of COVID-19 vaccination against PONV warrants further investigation. Keywords: Sedation, gastroentrology, complication
Erel et al. (Wed,) studied this question.