Seguridad de la sedación profunda con propofol administrada por gastroenterólogos en pacientes sometidos a Colangiopancreatografía Retrógrada Endoscópica (CPRE) en el Hospital Dr. Enrique Baltodano Briceño, entre los meses de noviembre del 2017 y agosto del 2018
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La sedación con propofol administrada por personal no anestesiólogo corresponde a una práctica clínica ampliamente utilizada durante los procedimientos endoscópicos. Existen datos limitados sobre la seguridad de la sedación profunda con propofol administrada por gastroenterólogos en la colangiopancreatografía retrógrada endoscópica (CPRE). Por tanto, el objetivo de este estudio fue evaluar la seguridad de la sedación con propofol administrada por un gastroenterólogo durante la CPRE. Pacientes y métodos: se realizó un estudio retrospectivo en el que se revisaron los expedientes clínicos de 108 pacientes que se sometieron a CPRE con sedación con propofol por gastroenterólogo durante el período comprendido entre noviembre de 2017 y agosto de 2018. Los pacientes se clasificaron por su edad, sexo, clasificación de la Sociedad Americana de Anestesiología (ASA), indicación del procedimiento, duración de la exploración y dosis de propofol utilizada. Asimismo, se registraron los eventos adversos asociados a la sedación (hipoxemia, hipotensión, bradicardia, necesidad de asistencia respiratoria, necesidad de líquidos intravenosos, uso de atropina y muerte). Resultados: se incluyeron 108 pacientes (66,7% mujeres y 33,3% hombres) durante un período de 10 meses. La dosis media de propofol utilizada fue de 448 mg ± 216 mg. De acuerdo con la clasificación ASA, 45.4% fueron ASA I, 42.6% ASA II, 9.3% ASA III y 2.8% ASA IV. La tasa de eventos adversos fue del 8,3%%, siendo la más frecuente la hipoxemia transitoria en el 7,4% de los pacientes, con solo el 1,8% (2 pacientes) que requirieron asistencia ventilatoria con bolsa mascarilla; seguido de hipotensión (2,7%) y bradicardia (0,9%). Un paciente requirió el uso de atropina (0,9%), mientras que dos requirieron líquidos intravenosos (1,8%). La duración más prolongada de la exploración se asoció con una mayor probabilidad de eventos adversos (p 0.002). No hubo asociación...
Inglés: Propofol sedation administered by non-anesthesiologists is a widely used clinical practice during endoscopic procedures. There is limited data concerning the safety of deep propofol sedation administered by gastroenterologists in endoscopic retrograde cholangiopancreatography (ERCP). The aim of our study was to assess the safety of gastroenterologist administered propofol sedation during ERCP. Patients and Methods: We performed a retrospective study in which we reviewed the medical charts of 108 patients that had an ERCP under propofol sedation during the period between November 2017 and August 2018. The patients were classified by their age, gender, American Society of Anesthesiologists Classification (ASA), indication of the procedure, duration of exploration and propofol dosage. Sedation associated adverse events (hypoxemia, hypotension, bradycardia, need for ventilatory assistance, need for intravenous fluids or atropine, and death) were recorded. Results: One hundred and eight patients (66.7% females and 33.3% males) during a period of 10 months were included. The mean propofol dose used was 448mg ± 216 mg. According to the ASA classification, 45.4% were ASA I, 42.6% were ASA II, 9.3% ASA III and 2.8% ASA IV. The rate of adverse events was 8.3%, with the most frequent being transitory hypoxemia in 7.4% of patients, with only 1.8% (2 patients) that required ventilatory assistance with bag mask; followed by hypotension (2.7%) and bradycardia (0.9%). One patient required the use of atropine (0.9%), while another two required intravenous fluids (1.8%). Longer duration of exploration was associated with higher likelihood of adverse events (p 0.002). There was no statistically significant association between the ASA classification and the rate of adverse events, nor did the age or total dose of propofol used, however a lower induction dose was associated with a higher probability of events (p 0.013) No sedation-related deaths were recorded...
Inglés: Propofol sedation administered by non-anesthesiologists is a widely used clinical practice during endoscopic procedures. There is limited data concerning the safety of deep propofol sedation administered by gastroenterologists in endoscopic retrograde cholangiopancreatography (ERCP). The aim of our study was to assess the safety of gastroenterologist administered propofol sedation during ERCP. Patients and Methods: We performed a retrospective study in which we reviewed the medical charts of 108 patients that had an ERCP under propofol sedation during the period between November 2017 and August 2018. The patients were classified by their age, gender, American Society of Anesthesiologists Classification (ASA), indication of the procedure, duration of exploration and propofol dosage. Sedation associated adverse events (hypoxemia, hypotension, bradycardia, need for ventilatory assistance, need for intravenous fluids or atropine, and death) were recorded. Results: One hundred and eight patients (66.7% females and 33.3% males) during a period of 10 months were included. The mean propofol dose used was 448mg ± 216 mg. According to the ASA classification, 45.4% were ASA I, 42.6% were ASA II, 9.3% ASA III and 2.8% ASA IV. The rate of adverse events was 8.3%, with the most frequent being transitory hypoxemia in 7.4% of patients, with only 1.8% (2 patients) that required ventilatory assistance with bag mask; followed by hypotension (2.7%) and bradycardia (0.9%). One patient required the use of atropine (0.9%), while another two required intravenous fluids (1.8%). Longer duration of exploration was associated with higher likelihood of adverse events (p 0.002). There was no statistically significant association between the ASA classification and the rate of adverse events, nor did the age or total dose of propofol used, however a lower induction dose was associated with a higher probability of events (p 0.013) No sedation-related deaths were recorded...
Descripción
Tesis (especialista en gastroenterología y endoscopía digestiva)--Universidad de Costa Rica. Sistema de Estudios de Posgrado. Programa de Estudios de Posgrado de Gastroenterología y Endoscopía, 2019
Palabras clave
ANESTESIA EN GASTROENTEROLOGIA, COLANGIOPANCREATOGRAFIA RETROGRADA ENDOSCOPICA, Hospital Dr. Enrique Baltodano Briceño (Liberia, Costa Rica), PANCREAS - ENFERMEDADES - DIAGNOSTICO, PROPOFOL - EFECTOS ADVERSOS, SEDACION PROFUNDA - MEDIDAS DE SEGURIDAD