Although moderate sedation is intended during elective gastrointestinal endoscopy, unintended levels of deep sedation occur.
Dr Vargo and colleagues from Ohio prospectively evaluated the incidence and risk factors of deep sedation during elective endoscopy.
The research team assessed the risk factors of this technique with meperidine and midazolam intended to maintain a level of moderate sedation.
The team enrolled 80 American Society of Anesthesiology class 1 to 2 outpatients.
The patients presented with elective esophagogastroduodenoscopy, and colonoscopy.
Endoscopic retrograde cholangiopancreatography (ERCP), and endoscopic ultrasonography were also undertaken in the patients.
| Deep sedation occurred in 68% of patients|
|American Journal of Gastroenterology|
Intravenous meperidine and midazolam were administered according to a standardized protocol.
The researchers assessed and recorded hemodynamic parameters and levels of sedation by a single observer at 3-minute intervals.
The Modified Observer's Assessment of Alertness/Sedation scale is a sedation assessment scale used to assess sedation levels.
The team recorded occurrence of deep sedation, defined by Modified Observer's Assessment of Alertness/Sedation 1 to 2.
Univariable and multivariable analyses were used to assess predictors of deep sedation.
The researchers observed that deep sedation occurred in 68% of patients for a total of 26% of total sedation assessments.
The percentage of deep sedation episodes of all sedation-level observations by procedure was 26% for esophagogastroduodenoscopy.
The team found that the percentage of deep sedation episodes of all sedation-level observations by procedure was 11% for colonoscopy.
The percentage of deep sedation episodes of all sedation-level observations by procedure for ERCP was 35%, and 29% for endoscopic ultrasonography.
Deep sedation occurred at least once in 60% with esophagogastroduodenoscopy, and 45% with colonoscopy.
In addition, the team found that deep sedation occurred in 85% with ERCP, and 80% with endoscopic ultrasonography.
Multivariable analysis showed that only ERCP and endoscopic ultrasonography were independent risk factors of deep sedation.
Dr Vargo's team commented, “Deep sedation occurs frequently during elective endoscopy with meperidine and midazolam used with the intent of moderate sedation.”
“ERCP and endoscopic ultrasonography are risk factors for the occurrence of deep sedation, independent of sedation dose or length of procedure.”