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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.