Single-agent versus combination regimens containing propofol: a retrospective cohort study of recovery metrics and complication rates in a hospital-based endoscopy suite
Regimes de agente único versus regimes de combinação contendo propofol: um estudo de coorte retrospectivo de métricas de recuperação e taxas de complicação em uma suíte de endoscopia hospitalar
Guozhen Xie, Maria Estevez, Kiyan Heybati, Matthew Vogt, Michael Smith, Christine Moshe, Johanna Chan, Vivek Kumbhari, Ryan Chadha
Abstract
Background
Anesthesiologists are often tasked with overseeing sedation in non-surgical settings. We aim to determine whether adding adjuvant sedatives to propofol affects the recovery
times and complication rates after endoscopy.
Methods
We conducted a retrospective cohort study of adults (≥18) who received propofol while undergoing esophagogastroduodenoscopy (EGD) and/or colonoscopy (COL) at a large academic institution over a four-year period. Patients receiving propofol alone were compared against patients receiving propofol in combination with midazolam, fentanyl, ketamine, or dexmedetomidine. The primary outcome was PACU length of stay, adjusted for age, sex, and ASA Score. Secondary outcomes included incidence of PACU postoperative nausea and vomiting, hypoxemia (SpO2 < 90%), bradycardia (HR < 60 bpm), and escalation of care (hospital admission), reported in adjusted odds ratios and their 95% confidence intervals.
Results
Across the study period, 28,532 cases were included. Colonoscopies performed under propofol+fentanyl sedation were associated with significantly longer PACU LOS compared to propofol alone. Adjusted mean PACU LOS was significantly longer in patients receiving adjuvant fentanyl, compared to propofol alone (p < 0.01) and propofol + dexmedetomidine (p < 0.01). Patients receiving propofol alone exhibited a 9.4% incidence of bradycardia, 16.0% hypoxia, 0.89% PONV, and 0.40% hospitalization. Adjuvant fentanyl use was associated with higher odds of hypoxia across all procedure types (p < 0.05). Adjuvant dexmedetomidine was associated with higher rates of bradycardia, but lower rates of hypoxia, PONV, and hospitalization (p < 0.05).
Conclusion
With the exception of fentanyl, combining propofol with other sedatives was not associated with longer recovery times. The incidence of complications differed significantly with the use of adjuvant fentanyl or dexmedetomidine.
Keywords
Resumo
Introdução
Anestesiologistas geralmente são encarregados de supervisionar a sedação em ambientes não cirúrgicos. Nosso objetivo é determinar se a adição de sedativos adjuvantes ao propofol afeta os tempos de recuperação e as taxas de complicações após a endoscopia.
Métodos
Conduzimos um estudo de coorte retrospectivo de adultos (≥18) que receberam propofol durante a realização de esofagogastroduodenoscopia (EGD) e/ou colonoscopia (COL) em uma grande instituição acadêmica durante um período de quatro anos. Pacientes que receberam propofol sozinho foram comparados a pacientes que receberam propofol em combinação com midazolam, fentanil, cetamina ou dexmedetomidina. O desfecho primário foi o tempo de internação na SRPA, ajustado para idade, sexo e pontuação ASA. Os desfechos secundários incluíram incidência de náusea e vômito pós-operatórios na SRPA, hipoxemia (SpO2 < 90%), bradicardia (FC < 60 bpm) e escalonamento de cuidados (admissão hospitalar), relatados em odds ratios ajustados e seus intervalos de confiança de 95%.
Resultados
Ao longo do período do estudo, 28.532 casos foram incluídos. Colonoscopias realizadas sob sedação com propofol+fentanil foram associadas a um tempo de internação na UCPA significativamente maior em comparação ao propofol sozinho. O tempo de internação na UCPA médio ajustado foi significativamente maior em pacientes recebendo fentanil adjuvante, em comparação ao propofol sozinho (p < 0,01) e propofol + dexmedetomidina (p < 0,01). Pacientes recebendo propofol sozinho exibiram uma incidência de 9,4% de bradicardia, 16,0% de hipóxia, 0,89% de NVPO e 0,40% de hospitalização. O uso de fentanil adjuvante foi associado a maiores chances de hipóxia em todos os tipos de procedimento (p < 0,05). A dexmedetomidina adjuvante foi associada a maiores taxas de bradicardia, mas menores taxas de hipóxia, NVPO e hospitalização (p < 0,05).
Conclusão
Com exceção do fentanil, a combinação de propofol com outros sedativos não foi associada a tempos de recuperação mais longos. A incidência de complicações diferiu significativamente com o uso de fentanil adjuvante ou dexmedetomidina.
Palavras-chave
References
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Submitted date:
11/03/2024
Accepted date:
01/31/2025
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