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- 저자 : Gowri Gouda (검색결과 2 건)
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Recent Developments in Devices Used for Gastrointestinal Endoscopy Sedation
Basavana Goudra,Gowri Gouda,Preet Mohinder Singh 대한소화기내시경학회 2021 Clinical Endoscopy Vol.54 No.2
Hypoxemia is a frequent and potentially fatal complication occurring in patients during gastrointestinal endoscopy. Theadministration of propofol sedation increases the risk of most complications, especially hypoxemia. Nevertheless, propofol has beenincreasingly used in the United States, and the trend is likely to increase in the years to come. Patient satisfaction and endoscopistsatisfaction along with rapid turnover are some of the touted reasons for this trend. However, propofol sedation generally impliesdeep sedation or general anesthesia. As a result, hypopnea and apnea frequently occur. Inadequate sedation and presence of irritableairway often cause coughing and laryngospasm, both leading to hypoxemia and potential cardiac arrest. Hence, prevention ofhypoxemia is of paramount importance. Traditionally, standard nasal cannula is used to administer supplement oxygen. However, itcannot sufficiently provide continuous positive airway pressure (CPAP) or positive pressure ventilation. Device manufacturers havestepped in to fill this void and created many types of cannulas that provide apneic insufflation of oxygen and CPAP and eliminatedead space. Such measures decrease the incidence of hypoxemia. This review aimed to provide essential information of some of thesedevices.
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Basavana Goudra,Ahmad Nuzat,Preet Mohinder Singh,Anuradha Borle,Augustus Carlin,Gowri Gouda 대한소화기내시경학회 2017 Clinical Endoscopy Vol.50 No.2
Background/Aims: The landscape of sedation for gastrointestinal (GI) endoscopic procedures and the nature of the procedures themselves have changed over the last decade. In this study, an attempt is made to analyze the frequency and etiology of all major adverse events associated with GI endoscopy. Methods: All adverse events extracted from the electronic database and local registry were analyzed. Although the data analysis was retrospective, the adverse events themselves were documented prospectively. These events were evaluated after subdivision into propofol-based anesthesia and intravenous conscious sedation groups. Results: Cardiorespiratory events, including cardiac arrest, were the most common adverse events during esophagogastroduodenoscopy, while bleeding was more frequent in patients undergoing colonoscopy. Pancreatitis was the most frequent adverse event in patients undergoing endoscopic retrograde cholangiopancreatography. The frequencies of most adverse events were significantly higher in patients anesthetized with propofol. Automatic regression modeling showed that the type of sedation, the American Society of Anesthesiologists physical status classification, and the procedure type were some of the predictors of immediate life-threatening complications. Conclusions: Clearly, our regression modeling suggests a strong association between the type of sedation as well as various patient factors and the frequency of adverse events. The possible reasons for our results are the changing demographics, the worsening comorbidities of the patient population, and the increasing technical complexity of these procedures. Although extensive use of propofol has increased patient satisfaction and procedure acceptability, its use is also associated with more frequent adverse events.
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