Obesity as a risk factor for sedation-related complications during propofol-mediated sedation for advanced endoscopic procedures.

Abstract

BACKGROUND:

There are limited data on the safety of anesthesia-assisted endoscopy by using propofol-mediated sedation in obese individuals undergoing advanced endoscopic procedures (AEPs).

OBJECTIVE:

To study the association between obesity (as measured by body mass index [BMI]) and the frequency of sedation-related complications (SRCs) in patients undergoing AEPs.

DESIGN:

Prospective cohort study.

SETTING:

Tertiary referral center.

PATIENTS:

A total of 1016 consecutive patients undergoing AEPs (BMI <30, 730 [72%]; 30-35, 159 [16%]; >35, 127 [12%]).

INTERVENTION:

Monitored anesthesia sedation with propofol alone or in combination with benzodiazepines and/or opioids.

MAIN OUTCOME MEASUREMENTS:

SRCs, airway maneuvers (AMs), hypoxemia, hypotension requiring vasopressors, and early procedure termination were compared across 3 groups.

RESULTS:

There were 203 AMs in 13.9% of patients, hypoxemia in 7.3%, need for vasopressors in 0.8%, and premature termination in 0.6% of patients. Increasing BMI was associated with an increased frequency of AMs (BMI <30, 10.5%; 30-35, 18.9%; >35-26.8%; P < .001) and hypoxemia (BMI <30, 5.3%; 30-35, 9.4%; >35, 13.4%; P = .001); there was no difference in the frequency of need for vasopressors (P = .254) and premature termination of procedures (P = .401). On multivariable analysis, BMI (odds ratio [OR] 2.0; 95% CI, 1.3-3.1), age (OR 1.1; 95% CI, 1.0-1.1), and American Society of Anesthesiologists class 3 or higher (OR 2.4; 95% CI, 1.1-5.0) were independent predictors of SRCs. In obese individuals (n = 286), there was no difference in the frequency of SRCs in patients receiving propofol alone or in combination (P = .48).

LIMITATIONS:

Single tertiary center study.

CONCLUSIONS:

Although obesity was associated with an increased frequency of SRCs, propofol sedation can be used safely in obese patients undergoing AEPs when administered by trained professionals.

• Authors: Sachin Wani, Riad Azar, Christine E Hovis, Robert M Hovis, Gregory A Cote, Matthew Hall, Lawrence Waldbaum, Vladimir Kushnir, Dayna Early, Daniel K Mullady, Faris Murad, Steven A Edmundowicz, Sreenivasa S Jonnalagadda
• Journal: Gastrointestinal endoscopy (Gastrointest Endosc) Vol. 74 Issue 6 Pg. 1238-47 (Dec 2011) ISSN: 1097-6779 [Electronic] United States
• PMID: 22136773 (Publication Type: Comparative Study, Journal Article)
• Copyright: Copyright © 2011 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.

Chemical References

• Anesthetics, Intravenous
• Propofol

Topics

• Aged
• Anesthetics, Intravenous (administration & dosage)
• Body Mass Index
• Conscious Sedation (adverse effects)
• Digestive System Diseases (complications, diagnosis)
• Endoscopy, Gastrointestinal (methods)
• Endosonography (methods)
• Female
• Follow-Up Studies
• Humans
• Hypotension (epidemiology, etiology)
• Hypoxia (epidemiology, etiology)
• Incidence
• Injections, Intravenous
• Male
• Middle Aged
• Obesity (complications)
• Odds Ratio
• Propofol (administration & dosage)
• Prospective Studies
• Risk Factors
• United States (epidemiology)