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

Wani, Sachin; Azar, Riad; Hovis, Christine E.; Hovis, Robert M.; Cote, Gregory A.; Hall, Matthew; Waldbaum, Lawrence; Kushnir, Vladimir; Early, Dayna; Mullady, Daniel K.; Murad, Faris; Edmundowicz, Steven A.; Jonnalagadda, Sreenivasa S.

doi:10.1016/j.gie.2011.09.006

« Previous Next »Gastrointestinal Endoscopy
Volume 74, Issue 6 , Pages 1238-1247, December 2011

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

Presented at the ASGE Topic Forum (Endoscopic Quality Outcomes), Digestive Disease Week, May 7-10, 2011, Chicago, Illinois (Gastrointest Endosc 2011;73:AB150).

Sachin Wani, MD
- Department of Medicine, Division of Gastroenterology and Hepatology, Washington University, St. Louis, Missouri
Riad Azar, MD
- Department of Medicine, Division of Gastroenterology and Hepatology, Washington University, St. Louis, Missouri
Christine E. Hovis, BS
- Department of Medicine, Division of Gastroenterology and Hepatology, Washington University, St. Louis, Missouri
Robert M. Hovis, CRNA
- Department of Anesthesiology, Washington University, St. Louis, Missouri
Gregory A. Cote, MD, MS
- Department of Medicine, Division of Gastroenterology, Indiana University School of Medicine, Indianapolis, Indiana, USA
Matthew Hall, PhD
- Department of Medicine, Division of Gastroenterology and Hepatology, Washington University, St. Louis, Missouri
Lawrence Waldbaum, MD
- Department of Anesthesiology, Washington University, St. Louis, Missouri
Vladimir Kushnir, MD
- Department of Medicine, Division of Gastroenterology and Hepatology, Washington University, St. Louis, Missouri
Dayna Early, MD
- Department of Medicine, Division of Gastroenterology and Hepatology, Washington University, St. Louis, Missouri
Daniel K. Mullady, MD
- Department of Medicine, Division of Gastroenterology and Hepatology, Washington University, St. Louis, Missouri
Faris Murad, MD
- Department of Medicine, Division of Gastroenterology and Hepatology, Washington University, St. Louis, Missouri
Steven A. Edmundowicz, MD
- Department of Medicine, Division of Gastroenterology and Hepatology, Washington University, St. Louis, Missouri
Sreenivasa S. Jonnalagadda, MD
- Department of Medicine, Division of Gastroenterology and Hepatology, Washington University, St. Louis, Missouri
- Reprint requests: Sreenivasa Jonnalagadda, MD, Division of Gastroenterology, Washington University at St. Louis, 660 South Euclid Avenue, Campus Box 8124, St. Louis, MO 63110

Received 26 May 2011; accepted 1 September 2011.

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.

Abbreviations: AEP, advanced endoscopic procedure, AM, airway maneuver, ASA, American Society of Anesthesiologists, BMI, body mass index, CRNA, certified registered nurse anesthetist, OR, odds ratio, SRC, sedation-related complication