

179
NATIONAL AUDIT INTO THE SAFETY OF DEEP SEDATION
14
Events were classified as sentinel risk in 342 (24.5%), moderate risk in 280 (20.1%), minor risk
in 709 (50.9%), and minimal risk in 63 (4.5%) of the cases (Tables 2 and 3).
Anaesthesiologists were called to events in general in 15.9% of the cases and to moderate
or sentinel risk incidents in 21% and 14.6% of the patients, respectively. In all other cases,
the SP was able to manage the sedation related AEs alone. The risk of a sedation related
AE significantly increased with ASA score (7.4%; 11.7%; 15.1% and 20.3% for ASA classes I
to IV (p<0.001)). The risk of a sentinel or moderate risk AE significantly increased with the
duration of the procedure. For procedures less than 60 minutes, the risk was 4.9%; between
61-120 minutes 12%; between 121-180 minutes 15,2%, and for procedures longer than 180
minutes 15.6% (p<0.001).
Respiratory AEs
There were 981 patients who experienced at least one respiratory incident. Incidents were a
desaturation of < 60 s to a SpO
2
75-90% in 547 (4.6%) and > 60 s to a SpO
2
<85%, or a SpO
2
< 70% in 61 (0.5%) cases. Apnoea for < 60 s occurred in 155 (1.3%) and apnoea for > 60 in 8
(0.07%) patients. Airway compromise necessitating an intervention (e.g. chin lift) occurred
in 390 (3.3%) patients. One patient experienced a bronchospasm as a result of an allergic
reaction. Ninety-six percent of the respiratory adverse events required an intervention.
These were additional sedatives in 21 (0.2%), antihistamine in 4 (0.03%), tactile stimulation
in 185 (1.6%), additional oxygen in 299 (2.5%), airway repositioning in 670 (5.6%), oral/nasal
airway 231 (1.9%), bag valve mask-assisted ventilation in 120 (1%), a laryngeal mask airway
in 4 (0.03%), CPAP in 7 (0.06%), reversal agents in 7 (0.06%), and tracheal intubation with
non-depolarising neuromuscular blocking drugs in 5 (0.07%) patients.
Vomiting
Vomiting occurred in 38 (0.3%) of the patients. Only 3 of these patients underwent
emergency procedures. In all of the cases the patients had fasted for at least 6 hours.
Twenty-eight patients required an intervention other than turning the (head of) patient and
oral suctioning. Seven patients (0.06%) aspirated, all received deep suctioning. Four patients
required intubation. Three patients needed to be admitted for on-going respiratory care in
the form of nebulising and observation for respiratory deterioration. None of the patients
developed aspiration pneumonia or required intensive care admission.
Aspiration occurred during endoscopic retrograde cholangiopancreatography (ERCP) (2),
oesophago-gastroduodenoscopy (2), colonoscopy (1), and others (2). No procedure was
significantly associated with aspiration.