Incidence of Complications in High-Risk Patients Undergoing Combined Esophagogastroduodenoscopy and Colonoscopy with Total Intravenous Anesthesia: A Prospective Cohort Study.

IF 2.8 3区 医学 Q1 Pharmacology, Toxicology and Pharmaceutics
Therapeutics and Clinical Risk Management Pub Date : 2025-09-26 eCollection Date: 2025-01-01 DOI:10.2147/TCRM.S541750
Wilaiporn Supan, Araya Ongiem, Papiroon Noitasaeng, Pathomporn Bunnag, Uayporn Kaosombatwattana, Orawan Supapueng, Phongthara Vichitvejpaisal
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引用次数: 0

Abstract

Objective: To evaluate the incidence, characteristics, and risk factors of complications related to anesthesia complication in ASA Class III patients undergoing combined esophagogastroduodenoscopy (EGD) and colonoscopy under total intravenous anesthesia (TIVA).

Materials and methods: This prospective cohort study was conducted from April 1, 2024, to February 11, 2025. Data collected included baseline characteristics (age, sex, comorbidities, functional capacity, nutritional status, smoking, fasting and medications) and intraoperative/postoperative parameters (anesthetic technique, sedative dosing, IV fluids, complications, and 24-hour status). Descriptive statistics, univariate analysis, and binary logistic regression were applied.

Results: Of 403 ASA Class III patients enrolled, 393 were analyzed after excluding 10 for inadequate bowel prep or early termination due to malignancy. A total of 207 patients (52.7%) experienced at least one complication. Common complications included transient hypotension (40.2%), desaturation (15.8%), and airway obstruction (15.5%). Less frequent events were bradycardia (4.1%), hypoxia (1.8%), hypertension (1.8%), tachycardia (0.3%) and respiratory depression (0.5%). Five independent risk factors were significantly associated with complications: preexisting cardiovascular disease - odds ratio (OR=1.678), respiratory disease (OR=1.877), functional capacity < 4 metabolic equivalents (METs), (OR=1.851), nutritional screening score ≥1 (OR =1.518), and single - dose bowel prep regimen (OR=1.614). Complications were more common in women, patients aged 65 years or older, and inpatients, although the difference in hospitalization and outpatient was not statistically significant. Patients with complications received lower total doses of propofol and fentanyl per weight per hour. Dexmedetomidine use was significantly associated with complications among inpatients (p = 0.015). The duration of the procedure was longer in patients with complications (p = 0.002).

Conclusion: Anesthesia-related complications were frequent among ASA Class III patients who underwent combined EGD and colonoscopy under TIVA, particularly cardiovascular and respiratory events. Identification of five preprocedural risk factors supports the need for improved risk stratification and individualized sedation planning to optimize safety in this high-risk group.

全静脉麻醉下进行食管胃十二指肠镜和结肠镜联合检查的高危患者并发症的发生率:一项前瞻性队列研究。
目的:评价全静脉麻醉(TIVA)下ASA III级患者行食管胃十二指肠镜(EGD)和结肠镜检查时麻醉相关并发症的发生率、特点及危险因素。材料与方法:本前瞻性队列研究于2024年4月1日至2025年2月11日进行。收集的数据包括基线特征(年龄、性别、合并症、功能能力、营养状况、吸烟、禁食和用药)和术中/术后参数(麻醉技术、镇静剂量、静脉输液、并发症和24小时状态)。采用描述性统计、单变量分析和二元逻辑回归。结果:纳入的403例ASA III级患者中,393例在排除10例肠道准备不足或因恶性肿瘤而早期终止后进行了分析。共有207例患者(52.7%)出现至少一种并发症。常见的并发症包括短暂性低血压(40.2%)、去饱和(15.8%)和气道阻塞(15.5%)。较少见的事件是心动过缓(4.1%)、缺氧(1.8%)、高血压(1.8%)、心动过速(0.3%)和呼吸抑制(0.5%)。5个独立危险因素与并发症显著相关:先前存在的心血管疾病-优势比(OR=1.678)、呼吸系统疾病(OR=1.877)、功能容量< 4代谢当量(METs) (OR=1.851)、营养筛查评分≥1 (OR= 1.518)和单剂量肠道准备方案(OR=1.614)。并发症在女性、65岁及以上患者和住院患者中更为常见,尽管住院和门诊患者的差异无统计学意义。有并发症的患者每小时每体重给予较低的异丙酚和芬太尼总剂量。右美托咪定的使用与住院患者的并发症显著相关(p = 0.015)。有并发症的患者手术时间更长(p = 0.002)。结论:ASA III级患者在TIVA下联合EGD和结肠镜检查时,麻醉相关并发症很常见,特别是心血管和呼吸事件。五个术前危险因素的识别支持了改进风险分层和个性化镇静计划的需要,以优化这一高危群体的安全性。
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来源期刊
Therapeutics and Clinical Risk Management
Therapeutics and Clinical Risk Management HEALTH CARE SCIENCES & SERVICES-
CiteScore
5.30
自引率
3.60%
发文量
139
审稿时长
16 weeks
期刊介绍: Therapeutics and Clinical Risk Management is an international, peer-reviewed journal of clinical therapeutics and risk management, focusing on concise rapid reporting of clinical studies in all therapeutic areas, outcomes, safety, and programs for the effective, safe, and sustained use of medicines, therapeutic and surgical interventions in all clinical areas. The journal welcomes submissions covering original research, clinical and epidemiological studies, reviews, guidelines, expert opinion and commentary. The journal will consider case reports but only if they make a valuable and original contribution to the literature. As of 18th March 2019, Therapeutics and Clinical Risk Management will no longer consider meta-analyses for publication. The journal does not accept study protocols, animal-based or cell line-based studies.
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