Abstract :
Background: Previous studies have reported hypoxemia as occurring during EGD. (EGD) and causing
cardiorespiratory complications. Many factors have been implicated in oxygen desaturation during sedated endoscopy. Whether hypoxemia during EGD is predominantly due to the effects of sedation remains uncertain.
Objective: To compare the incidence of hypoxemia during upper gastrointestinal endoscopy in patient with and without sedations.
Patients and Methods: Published studies in English were identified by searching MEDLINE from 1988 to 2004. Studies were selected if they were controlled trials involving patients aged 16 and including at least 10 cases each in both the sedated and the non-sedated groups. Data were extracted on study quality, sample size, intervention and control, outcomes of hypoxemia, mean lowest oxygen saturation and
complications .
Results: Fourteen clinical controlled trials were considered eligible for the review. Of these, 2 were
excluded. One excluded study because the recruitment included patients who underwent EGD, colonoscopy and endoscopic retrograde cholangiopancreatography. Another study was excluded due to the oxygen application to all patients during the procedure. Twelve studies were finally included in the meta-analysis. Midazolam was used in 7 studies. Of those studies using midazolam, one study compared midazolam with propofol and with control. Three studies employed diazepam, one using meperidine and the other one using flunitrazepam. Hypoxemia significantly occurred in patients with IV sedation more frequently than patients without IV sedation (odds ration 2.42, 95% confidence interval 1.47-3.98). The mean lowest oxygen saturation in sedated patients was 63% lower than those in non-sedated patients.
Conclusion: This meta-analysis suggested that hypoxemia occurs during upper gastrointestinal endo-
scopy, both with and without sedation. Intravenous sedation significantly increased the risk of hypoxemia as compared to non-sedation. Midazolam was the most commonly used drug for sedation during endoscopy in this study.
[Thai J Gastroenterol 2005; 6(3): 149-153] |
file/Thai-Journal-of-gastroenterology-vol-6-no-3-2807254.pdf