Aims Describe risk-related factors of desaturation during EUS sedation taken into account the clinical and facial characteristics.
Tab. 1
Baseline characteristics and desaturation risk factors
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BASELINE CHARACTERISTICS Age > 65 years Performance status regular/bad IMC > 35 % Sleep Apnea ASA I–II ASA ≥ III
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19% 23% 5.2% 22% 66% 34%
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CRANIUM FACIAL CHARACTERISTICS Cranio-facial deformity Short necks (tiromentonian distance < 6 cm) Mouth openings (interdental distance < 3 cm) Mandibular retrognathism (hiodomentonian distance < 3 cm) Mandibular subluxation < 0
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15% 11% 3% 11% 12%
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SEDATION Average time Propofol Propofol + midazolam Propofol + fentanyl
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42 ± 17 min 59.9% 39.2% 0.9%
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Methods Prospective analysis of upper echoendoscopies sedated with propofol administered for expert endoscopic team, between December 2017-July 2019. The variables included in the table1 and adverse effects related to sedation were analysed as SBP < 70/ > 230, HR < 40x ´/ > 120x´, SPO2 < 90%, bronchospasm and laryngospasm.
Results 324 patients age: 65 ± 13 years, 53% men. The characteristics of population are described in Table 1. 49 patients (17%) presented adverse events: desaturation < 90% (11.5%), Severe Adverse Events (6,2%): Sat02 < 70% (1,9%), hypotension (0,6%), tachycardia (0,3%), hypertension (0,6%), laryngospasm (3,4%). 3 patients need ventilatory support (Ambu). None intubation or cardiac arrest.
Patients with age > 65 (18,8% p = 0.017), sleep apnea (28,6% p = 0.000), mandibular subluxation (31.6%, p = 0.005), short neck (29.4% p = 0, 016) and mandibula retrognatism (32,4% p = 0.002) had a higher risk of adverse effects in univariate analysis. Of these, age > 65 (OR 2.13; 95%CI 1.06–4.27), sleep apnea (OR 2.68; 95%CI 1.34–5.36), short necks (OR = 2.43; 95%CI: 1.01–5.87;
p = 0.048) and mandibular subluxation (OR: 2.73; 95% CI 1.18–6.32) were independent predictors of adverse effects related to sedation.
Conclusions Difficult airway parameters, imply a high risk of complications in sedation for upper echoendoscopy. Consequently, measures to prevent hypoventilation in patients with these characteristics must be considered.
