Sedation reversal trends at outpatient ambulatory endoscopic center vs in-hospital ambulatory procedure center using a triage protocol  

作　　者：Saqib Walayat Peter Stadmeyer Azfar Hameed Minahil Sarfaraz Paul Estrada Mark Benson Anurag Soni Patrick Pfau Paul Hayes Brittney Kile Toni Cruz Deepak Gopal 

机构地区：[1]Department of Gastroenterology,University of Illinois,Peoria,IL 61605,United States [2]Department of Gastroenterology,University of Wisconsin,Madison,WI 53792,United States [3]Department of Internal Medicine,Texas Health Denton,Denton,TX 76201,United States [4]Department of Internal Medicine,Allama Iqbal Medical College,Lahore 042,Pakistan [5]Department of Gastroenterology,Texas Tech University Health Services Center,El Paso,TX 79911,United States [6]Department of Gastroenterology and Hepatology,University of Wisconsin,Madison,WI 53705,United States [7]Finance Business Partners UW Health,University of Wisconsin,Madison,WI 53792,United States [8]UW Health Digestive Health Center Endoscopy,University of Wisconsin,Madison,WI 53792,United States [9]Division of Gastroenterology and Hepatology,Department of Medicine,University of Wisconsin Hospitals and Clinics,Madison,WI 53705,United States

出　　处：《World Journal of Gastrointestinal Endoscopy》2024年第7期413-423,共11页世界胃肠内镜杂志（英文版）（电子版）

摘　　要：BACKGROUND Routine outpatient endoscopy is performed across a variety of outpatient settings.A known risk of performing endoscopy under moderate sedation is the potential for over-sedation,requiring the use of reversal agents.More needs to be reported on rates of reversal across different outpatient settings.Our academic tertiary care center utilizes a triage tool that directs higher-risk patients to the in-hospital ambulatory procedure center(APC)for their procedure.Here,we report data on outpatient sedation reversal rates for endoscopy performed at an inhospital APC vs at a free-standing ambulatory endoscopy digestive health center(AEC-DHC)following risk stratification with a triage tool.AIM To observe the effect of risk stratification using a triage tool on patient outcomes,primarily sedation reversal events.METHODS We observed all outpatient endoscopy procedures performed at AEC-DHC and APC from April 2013 to September 2019.Procedures were stratified to their respective sites using a triage tool.We evaluated each procedure for which sedation reversal with flumazenil and naloxone was recorded.Demographics and characteristics recorded include patient age,gender,body mass index(BMI),American Society of Anesthesiologists(ASA)classification,procedure type,and reason for sedation reversal.RESULTS There were 97366 endoscopic procedures performed at AEC-DHC and 22494 at the APC during the study period.Of these,17 patients at AEC-DHC and 9 at the APC underwent sedation reversals(0.017%vs 0.04%;P=0.06).Demographics recorded for those requiring reversal at AEC-DHC vs APC included mean age(53.5±21 vs 60.4±17.42 years;P=0.23),ASA class(1.66±0.48 vs 2.22±0.83;P=0.20),BMI(27.7±6.7 kg/m^(2) vs 23.7±4.03 kg/m^(2);P=0.06),and female gender(64.7%vs 22%;P=0.04).The mean doses of sedative agents and reversal drugs used at AEC-DHC vs APC were midazolam(5.9±1.7 mg vs 8.9±3.5 mg;P=0.01),fentanyl(147.1±49.9μg vs 188.9±74.1μg;P=0.10),flumazenil(0.3±0.18μg vs 0.17±0.17μg;P=0.13)and naloxone(0.32±0.10 mg vs 0.28±0.12 m

关 键 词：Ambulatory care Conscious sedation Endoscopy Colonoscopy Risk assessment Risk factors 

分 类 号：R65[医药卫生—外科学]