Evaluation of safe, effective intravenous sedation for utilization in endoscopic procedures

Summary

The prevention of anesthetic mishaps during endoscopic procedures is of great importance to physicians in training. With the large number of such procedures performed each year, even infrequent adverse anesthetic reactions may result in a significant number of problems. To establish the safety and efficacy of an anesthetic regimen using intravenous meperidine and diazepam, all endoscopic procedures performed at one teaching institution in a 4-month period were retrospectively analyzed with regard to: (1) type and dosage of sedation/anesthesia, (2) endoscopic procedure involved, (3) effect of any underlying disease state, (4) side effects, (5) endoscopic complications, and (6) overall patient acceptance. A total of 716 patients underwent 913 endoscopic procedures with 876 separate anesthetic/intravenous sedations. General anesthesia was utilized in 44% of the 155 pediatric procedures. In the adult patients, intravenous sedation was administered by a physician-in-training under supervision except in 9% of cases (66 patients) when intravenous sedation utilizing alternative agents was given by the anesthesia department. The dose of sedation used (per body weight) declined with increasing age in the pediatric group (0–19 years). The adult dose remained constant for the next eight decades of life (meperidine 0.76±0.33 mg/kg; diazepam 0.12±0.08 mg/kg). In the adult group, 758 procedures were performed: 371 patients underwent esophagogastroduodenoscopy, 258 colonoscopy, 36 endoscopic retrograde cholangiopancreatography, 40 flexible sigmoidoscopy, and 51 percutaneous endoscopic gastrostomy. Anesthetic-related complications (transient apnea and itching), were noted in two patients, and naloxone was utilized to reverse oversedation in a further 17 (2.56%). Three perforations occurred [two colonic, one esophageal (0.42%)] and were recognized immediately. Overall, patient acceptance of intravenous sedation was good (86%). Thus, intravenous sedation utilizing meperidine and diazepam has been shown to be reproducible, safe, and very effective during endoscopic training.