1Department of Clinical Anesthesiology and Critical Care, Perelman School of Medicine, Philadelphia, PA, USA
2Department of Endoscopy, Hospital of the University of Pennsylvania, Perelman Center for Advanced Medicine, Philadelphia, PA, USA
3Department of Anesthesiology and Critical Care Medicine, All India Institute of Medical Sciences, New Delhi, India
4Department of Anesthesia, All India Institute of Medical Sciences, New Delhi, India
Copyright © 2017 Korean Society of Gastrointestinal Endoscopy
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Adverse event |
A (n=14,534) |
S (n=16,907) |
NA |
Total (n=31,441) |
|||
---|---|---|---|---|---|---|---|
Frequency | Incidence | Frequency | Incidence | Frequency | Frequency | Incidence | |
Cardiorespiratory arresta) | 13 | 8.940 | 0 | 0 | 1 | 14 | 4.433 |
Postprocedure pain | 4 | 2.751 | 3 | 1.770 | 3 | 10 | 3.167 |
Bleed | 3 | 2.063 | 3 | 1.770 | 2 | 8 | 2.533 |
Non-cardiac chest pain | 2 | 1.375 | 2 | 1.180 | 0 | 4 | 1.267 |
Arrhythmias | 2 | 1.375 | 0 | 0 | 1 | 3 | 0.950 |
Hypoxia | 3 | 2.063 | 0 | 0 | 0 | 3 | 0.950 |
Perforation | 3 | 2.063 | 0 | 0 | 0 | 3 | 0.950 |
Iatrogenic | 2 | 1.375 | 0 | 0 | 0 | 2 | 0.633 |
Myocardial infarction | 2 | 1.375 | 0 | 0 | 0 | 2 | 0.633 |
Pancreatitis | 2 | 1.375 | 0 | 0 | 0 | 2 | 0.633 |
Tooth break | 2 | 1.375 | 0 | 0 | 0 | 2 | 0.633 |
Anaphylaxis | 0 | 0 | 0 | 0 | 1 | 1 | 0.317 |
Cognitive dysfunction | 1 | 0.688 | 0 | 0 | 0 | 1 | 0.317 |
Hemodynamic | 0 | 0 | 1 | 0.590 | 0 | 1 | 0.317 |
Obstruction | 1 | 0.688 | 0 | 0 | 0 | 1 | 0.317 |
Seizures | 0 | 0 | 1 | 0.590 | 0 | 1 | 0.317 |
Sore throat | 1 | 0.688 | 0 | 0 | 0 | 1 | 0.317 |
Stricture | 1 | 0.688 | 0 | 0 | 0 | 1 | 0.317 |
Total | 42 | 28.883 | 10 | 6 | 8 | 60 | 19.000 |
Adverse event |
A (n=3,694) |
S (n=1,545) |
Total (n=5,239) |
|||
---|---|---|---|---|---|---|
Frequency | Incidence | Frequency | Incidence | Frequency | Incidence | |
Pancreatitisa) | 14 | 37.900 | 1 | 6.472 | 15 | 28.631 |
Bleeda) | 5 | 13.535 | 0 | 0 | 5 | 9.544 |
Febrile reactiona) | 4 | 10.828 | 0 | 0 | 4 | 7.635 |
Cardiorespiratory arrest | 2 | 5.414 | 1 | 6.472 | 3 | 5.726 |
Postprocedural pain | 2 | 5.414 | 0 | 0 | 2 | 3.818 |
Arrhythmias | 1 | 2.707 | 0 | 0 | 1 | 1.909 |
Hypoxia | 1 | 2.707 | 0 | 0 | 1 | 1.909 |
Iatrogenic | 1 | 2.707 | 0 | 0 | 1 | 1.909 |
Miscellaneous | 1 | 2.707 | 0 | 0 | 1 | 1.909 |
Total | 31 | 83.920 | 2 | 12.945 | 33 | 62.989 |
Factor |
Life threatening vs. Non-life threatening |
|
---|---|---|
Standardized coefficients βa) | Statistical significance (p-value) | |
BMI | –0.179 | 0.103 |
MMP | 0.188 | 0.112 |
ASAb) | 0.243 | 0.032 |
Age at surgery | 0.056 | 0.639 |
Procedure typec) | 0.210 | 0.041 |
Sedation typed) | 0.428 | 0.002 |
Overall predictability | 26.81% (p=0.001) |
BMI, body mass index; MMP, Mallampatti airway class; ASA, American Society of Anesthesiologists.
a)The strength of association is shown by “β coefficient” and the negative β coefficient denotes a negative relation between factor and outcome (life threatening complications included cardiorespiratory arrest, significant hypoxia [needing immediate intervention] and myocardial infarction);
b)American Society of Anaesthesiologists status 3 and above is associated with higher risk life threatening events;
c)Endoscopic retrograde cholangiopancreatography is associated with higher risk of life threatening events;
d)Propofol sedation is associated with higher risk of life threatening events.
Adverse event | Frequency |
|||
---|---|---|---|---|
A | S | Not available | Total | |
1. Bleed | 21 | 18 | 12 | 51 |
2. Cardiorespiratory arrest | 16 | 4 | 1 | 21 |
3. Postprocedural pain | 10 | 6 | 4 | 20 |
4. Pancreatitis | 16 | 1 | 0 | 17 |
5. Arrhythmias | 5 | 2 | 1 | 8 |
6. Febrile reaction | 4 | 1 | 1 | 6 |
7. Non-cardiac chest pain | 2 | 4 | 0 | 6 |
8. Perforation | 3 | 1 | 1 | 5 |
9. Hypoxia | 4 | 0 | 0 | 4 |
10. Iatrogenic | 3 | 1 | 0 | 4 |
11. Hemodynamic | 1 | 2 | 0 | 3 |
12. Myocardial infarction | 2 | 0 | 0 | 2 |
13. Miscellaneous | 1 | 0 | 1 | 2 |
14. Obstruction | 2 | 0 | 0 | 2 |
15. Tooth break | 2 | 0 | 0 | 2 |
16. Anaphylaxis | 0 | 0 | 1 | 1 |
17. Aspiration pneumonia | 1 | 0 | 0 | 1 |
18. Cognitive dysfunction | 1 | 0 | 0 | 1 |
19. Dyspnoea | 0 | 0 | 1 | 1 |
20. GI obstruction | 0 | 0 | 1 | 1 |
21. Seizures | 0 | 1 | 0 | 1 |
22. Sore throat | 1 | 0 | 0 | 1 |
23. Stricture | 1 | 0 | 0 | 1 |
24. Stridor | 1 | 0 | 0 | 1 |
25. Syncope | 0 | 1 | 0 | 1 |
Total | 97 | 42 | 24 | 163 |
Adverse event | A (n=14,534) |
S (n=16,907) |
NA |
Total (n=31,441) |
|||
---|---|---|---|---|---|---|---|
Frequency | Incidence | Frequency | Incidence | Frequency | Frequency | Incidence | |
Cardiorespiratory arrest |
13 | 8.940 | 0 | 0 | 1 | 14 | 4.433 |
Postprocedure pain | 4 | 2.751 | 3 | 1.770 | 3 | 10 | 3.167 |
Bleed | 3 | 2.063 | 3 | 1.770 | 2 | 8 | 2.533 |
Non-cardiac chest pain | 2 | 1.375 | 2 | 1.180 | 0 | 4 | 1.267 |
Arrhythmias | 2 | 1.375 | 0 | 0 | 1 | 3 | 0.950 |
Hypoxia | 3 | 2.063 | 0 | 0 | 0 | 3 | 0.950 |
Perforation | 3 | 2.063 | 0 | 0 | 0 | 3 | 0.950 |
Iatrogenic | 2 | 1.375 | 0 | 0 | 0 | 2 | 0.633 |
Myocardial infarction | 2 | 1.375 | 0 | 0 | 0 | 2 | 0.633 |
Pancreatitis | 2 | 1.375 | 0 | 0 | 0 | 2 | 0.633 |
Tooth break | 2 | 1.375 | 0 | 0 | 0 | 2 | 0.633 |
Anaphylaxis | 0 | 0 | 0 | 0 | 1 | 1 | 0.317 |
Cognitive dysfunction | 1 | 0.688 | 0 | 0 | 0 | 1 | 0.317 |
Hemodynamic | 0 | 0 | 1 | 0.590 | 0 | 1 | 0.317 |
Obstruction | 1 | 0.688 | 0 | 0 | 0 | 1 | 0.317 |
Seizures | 0 | 0 | 1 | 0.590 | 0 | 1 | 0.317 |
Sore throat | 1 | 0.688 | 0 | 0 | 0 | 1 | 0.317 |
Stricture | 1 | 0.688 | 0 | 0 | 0 | 1 | 0.317 |
Total | 42 | 28.883 | 10 | 6 | 8 | 60 | 19.000 |
Adverse event | A (n=3,694) |
S (n=1,545) |
Total (n=5,239) |
|||
---|---|---|---|---|---|---|
Frequency | Incidence | Frequency | Incidence | Frequency | Incidence | |
Pancreatitis |
14 | 37.900 | 1 | 6.472 | 15 | 28.631 |
Bleed |
5 | 13.535 | 0 | 0 | 5 | 9.544 |
Febrile reaction |
4 | 10.828 | 0 | 0 | 4 | 7.635 |
Cardiorespiratory arrest | 2 | 5.414 | 1 | 6.472 | 3 | 5.726 |
Postprocedural pain | 2 | 5.414 | 0 | 0 | 2 | 3.818 |
Arrhythmias | 1 | 2.707 | 0 | 0 | 1 | 1.909 |
Hypoxia | 1 | 2.707 | 0 | 0 | 1 | 1.909 |
Iatrogenic | 1 | 2.707 | 0 | 0 | 1 | 1.909 |
Miscellaneous | 1 | 2.707 | 0 | 0 | 1 | 1.909 |
Total | 31 | 83.920 | 2 | 12.945 | 33 | 62.989 |
Adverse event | A (n=9,767) |
S (n=23,536) |
NA |
Total (n=33,303) |
|||
---|---|---|---|---|---|---|---|
Frequency | Incidence | Frequency | Incidence | Frequency | Frequency | Incidence | |
Bleed | 13 | 13.310 | 13 | 5.523 | 10 | 36 | 10.810 |
Postprocedural pain | 3 | 3.072 | 2 | 0.850 | 1 | 6 | 1.802 |
Arrhythmias | 2 | 2.048 | 2 | 0.850 | 0 | 4 | 1.201 |
Cardiorespiratory arrest | 1 | 1.024 | 2 | 0.850 | 0 | 3 | 0.900 |
Febrile reaction | 0 | 0 | 1 | 0.425 | 1 | 2 | 0.601 |
Hemodynamic | 1 | 1.024 | 1 | 0.425 | 0 | 2 | 0.601 |
Perforation | 0 | 0 | 1 | 0.425 | 1 | 2 | 0.601 |
Aspiration pneumonia | 1 | 1.024 | 0 | 0 | 0 | 1 | 0.300 |
Dyspnoea | 0 | 0 | 0 | 0 | 1 | 1 | 0.300 |
GI obstruction | 0 | 0 | 0 | 0 | 1 | 1 | 0.300 |
Non-cardiac chest pain | 0 | 0 | 1 | 0.425 | 0 | 1 | 0.300 |
Obstruction | 1 | 1.024 | 0 | 0 | 0 | 1 | 0.300 |
Stridor | 1 | 1.024 | 0 | 0 | 0 | 1 | 0.300 |
Total | 23 | 23.549 | 23 | 9.772 | 15 | 61 | 18.317 |
Propofol | Intravenous conscious sedation | p-value (chi-square test) | |
---|---|---|---|
Cardiac arrest | 6.069 | 0.666 | <0.0001 |
Pancreatitis | 5.698 | 0.222 | <0.0001 |
Postprocedure pain | 3.561 | 1.322 | <0.0001 |
Febrile reaction | 1.780 | 0.222 | <0.0001 |
Iatrogenic | 2.137 | 0.222 | <0.0001 |
Factor | Life threatening vs. Non-life threatening |
|
---|---|---|
Standardized coefficients β |
Statistical significance (p-value) | |
BMI | –0.179 | 0.103 |
MMP | 0.188 | 0.112 |
ASA |
0.243 | 0.032 |
Age at surgery | 0.056 | 0.639 |
Procedure type |
0.210 | 0.041 |
Sedation type |
0.428 | 0.002 |
Overall predictability | 26.81% (p=0.001) |
A, anesthesia provider administered sedation; S, gastrointestinal endoscopist directed sedation; GI, gastrointestinal.
A, anesthesia provider administered sedation; S, gastrointestinal endoscopist directed sedation; NA, not available. Statistically significant different values using chi-square test (
A, anesthesia provider administered sedation; S, gastrointestinal endoscopist directed sedation. Statistically significant different values using chi-square test (
None of the values were statistically different in any of the groups. A, anesthesia provider administered sedation; S, gastrointestinal endoscopist directed sedation; NA, not available; GI, gastrointestinal.
BMI, body mass index; MMP, Mallampatti airway class; ASA, American Society of Anesthesiologists. The strength of association is shown by “β coefficient” and the negative β coefficient denotes a negative relation between factor and outcome (life threatening complications included cardiorespiratory arrest, significant hypoxia [needing immediate intervention] and myocardial infarction); American Society of Anaesthesiologists status 3 and above is associated with higher risk life threatening events; Endoscopic retrograde cholangiopancreatography is associated with higher risk of life threatening events; Propofol sedation is associated with higher risk of life threatening events.