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

• Published in: Gastrointestinal endoscopy Vol. 74; no. 6; pp. 1238 - 1247
• Main Authors: Wani, Sachin, MD, Azar, Riad, MD, Hovis, Christine E., BS, Hovis, Robert M., CRNA, Cote, Gregory A., MD, MS, Hall, Matthew, PhD, Waldbaum, Lawrence, MD, Kushnir, Vladimir, MD, Early, Dayna, MD, Mullady, Daniel K., MD, Murad, Faris, MD, Edmundowicz, Steven A., MD, Jonnalagadda, Sreenivasa S., MD
• Format: Journal Article
• Language: English
• Published: Maryland heights, MO Mosby, Inc 01-12-2011; Elsevier
• Subjects: Aged; Anesthesia; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anesthetics, Intravenous - administration & dosage; Biological and medical sciences; Body Mass Index; Conscious Sedation - adverse effects; Digestive System Diseases - complications; Digestive System Diseases - diagnosis; Endoscopy, Gastrointestinal - methods; Endosonography - methods; Female; Follow-Up Studies; Gastroenterology and Hepatology; Gastroenterology. Liver. Pancreas. Abdomen; General anesthesia. Technics. Complications. Neuromuscular blocking. Premedication. Surgical preparation. Sedation; Humans; Hypotension - epidemiology; Hypotension - etiology; Hypoxia - epidemiology; Hypoxia - etiology; Incidence; Injections, Intravenous; Male; Medical sciences; Metabolic diseases; Middle Aged; Obesity; Obesity - complications; Odds Ratio; Propofol - administration & dosage; Prospective Studies; Risk Factors; United States - epidemiology; advanced endoscopic procedure; OR; SRC; body mass index; sedation-related complication; American Society of Anesthesiologists; odds ratio; AEP; AM; certified registered nurse anesthetist; ASA; CRNA; airway maneuver; BMI; Obesity; General anesthetic; Nutrition disorder; Risk factor; Gastroenterology; Complication; Endoscopy; Propofol; Sedation; Nutritional status
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/j.gie.2011.09.006

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.