Digestive Diseases and Sciences

, Volume 57, Issue 7, pp 1899–1907

Prospective Description of Coughing, Hemodynamic Changes, and Oxygen Desaturation During Endoscopic Sedation

  • Abdul Hamid El Chafic
  • George Eckert
  • Douglas K. Rex
Original Article

DOI: 10.1007/s10620-012-2057-z

Cite this article as:
El Chafic, A.H., Eckert, G. & Rex, D.K. Dig Dis Sci (2012) 57: 1899. doi:10.1007/s10620-012-2057-z

Abstract

Background

Deep sedation is increasingly used for endoscopy. The impact of sedation level on hemodynamic status, oxygenation, and aspiration risk is incompletely described.

Aims

To describe the incidence of intraprocedural cough, hemodynamic changes, oxygen desaturation, and their relationship to clinical factors and sedation level.

Methods

Detailed prospective recordings of hemodynamic changes, oxygen desaturation, and cough during 757 nonemergent endoscopic procedures done under sedation using propofol, midazolam, and/or fentanyl.

Results

Thirteen percent of patients had at least one cough and 3% had prolonged cough. Cough was more common in nonsmokers (P = 0.05), upper endoscopy (P < 0.0001), with propofol (P = 0.0008), longer procedures (P = 0.0001), and hiccups (P = 0.01). The association between supine positioning during colonoscopy and cough approached significance (P = 0.06). Oxygen desaturation was rare (4%) and associated only with deep sedation (P = 0.02). Mean systolic and diastolic blood pressure (BP) dropped by 7.3 and 5.6% respectively. Decreases in systolic BP were more common in whites (P = 0.03), males (P = 0.004), nonsmokers (P = 0.04), during colonoscopy (P < 0.0001), and in patients receiving midazolam and fentanyl (P = 0.01). Heart rate (HR) dropped >20% from baseline in 15% of patients and was more common during colonoscopy (P = 0.002). HR increased >20% in 20% of patients and was more common with coughing (P < 0.0001) and in younger patients (P = 0.0002). No patient required pharmacologic treatment of BP or HR.

Conclusions

We have described procedural predictors of cough that may help clinicians reduce the risk of aspiration during endoscopy. Hemodynamic changes during endoscopy are common but largely clinically insignificant.

Keywords

Endoscopy, digestive system/adverse effectsDeep sedation/adverse effectsPropofol/adverse effectsHemodynamicsCoughOxygen saturation

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Abdul Hamid El Chafic
    • 1
  • George Eckert
    • 1
  • Douglas K. Rex
    • 1
  1. 1.Division of Gastroenterology, Department of MedicineIndiana University School of MedicineIndianapolisUSA