Outcomes of Anesthesia-Supported versus Endoscopist-Driven Sedation Modalities: A retrospective cohort study.

Abstract

Background and aims: Anesthesia involvement has become commonplace in many procedural settings. The goal of this study is to compare sedation modalities utilized by endoscopists and anesthesiologists in the endoscopy suite, particularly with respect to recovery time and adverse events.

Methods: We conducted a retrospective cohort study including adults (≥18) undergoing outpatient EGD and/or colonoscopy at Mayo Clinic in Jacksonville, Florida between October 1, 2018 through December 31, 2022. Cases were clasified as utilizing Propofol only, Propofol±Adjuvants (including Dexmedetomidine, Ketamine, Fentanyl, Midazolam), General Anesthesia with Endotracheal Tube, or Midazolam/Fentanyl only. The primary outcome was length of stay in the post-anesthesia care unit (PACU LOS), and secondary outcomes included incidence of postoperative nausea and vomiting (PONV), hypoxemia (SpO2

Results: 56,361 cases were included in the analysis. Among patients who received Midazolam/Fentanyl sedation, mean PACU LOS was 52.01, 49.68, and 53.24 minutes for EGD, COL, and Combined procedures, respectively. This was significantly higher than 44.65, 41.41, 41.92 for General Anesthesia, 32.35, 35.75, 33.42 for Propofol + Adjuvants, and 31.63, 32.61, 33.29 for Propofol (p<0.0001). Of the patient receiving Midazolam/Fentanyl, 8.39% experienced bradycardia, 6.12% experienced hypoxia, 0.24% experienced PONV, and 0.05% were hospitalized. These were substantially lower than the rates for other sedation groups, and odds ratios were significantly lower than 1.00 (p<0.05) in 30 out of 36 comparisons across procedural, sedative, and outcome categories.

Conclusions: Sedation achieved with Midazolam/Fentanyl correlated with a lower rate of adverse events but significantly longer PACU LOS compared to Propofol, Propofol + Adjuvants, or General Anesthesia.