Authors : Amornyotin S, Prakanrattana U, Chalayonnavin W, Kongphlay S
Volume : 35
Issue : 3
Year : 2009
Page No : 181-190
Background : Endoscopic ultrasonography (EUS) is a procedure for diagnosis and treatment in patients with abnormality of gastrointestinal tract and adjacent organs. It commonly performed under intravenous sedation. The efficacy by which a patient is sedated remains controversial. Objective : To evaluate the clinical efficacy of intravenous sedation for the EUS procedure in Siriraj Hospital. Methods : The patients on whom EUS had been performed by using intravenous sedation (IVS) during the period of September, 2005 to February, 2009 at Siriraj GI Endoscopy Center were retrospective analyzed. The patients’ characteristics, pre-sedation problems, sedative agents, time and complications were assessed. Results : During the study period, a total of 521 EUS procedures were reviewed. Of these, 513 patients (249 male and 264 female ; mean age 55.2 ± 15.3 years and ranged from 17 year to 97 years) were performed under IVS technique. Most patients were classified in ASA class I or II (43.6%, 47.4%). Mean sedation time was 52.3 ± 23.7 minutes and ranged from 15 to 225 minutes. Indications for EUS were pancreatic abnormality (38.4%), gastric abnormality (19.5%), hepatobiliary abnormality (14.4%), abdominal pain (10.1%), esophageal tumor (5.5%), abdominal lymphadenopathy (4.9%), abdominal mass (2.1%) and others (5.1%). Preanesthetic problems were hypertension (16.2%), hematalogic diseases (13.1%) and diabetes mellitus (9.2%). Of 513 patients, 332 procedures (64.7%) were performed only for diagnosis. Pancreas, stomach and hepatobiliary tract were the main target organs. The main sedative agents used were propofol, fentanyl and midazolam. Mean dose of propofol in patients aged < 60 years was significantly higher than in the other aged groups. However, the mean dose of fentanyl and midazolam was not significantly different. The combination of propofol, fentanyl and midazolam was commonly used. Overall complication rate was 40.7%. Cardiovascular adverse event including hypotension was the most frequent sedative complication. By comparison according to age, ASA physical status and combination of sedative agents, all adverse events were not significantly different. Conclusion : IVS performed by anesthetic personnel for EUS procedure is relatively safe and effective. Serious adverse events are rare.