183 / 242
183
NATIONAL AUDIT INTO THE SAFETY OF DEEP SEDATION
14
Patient outcomes
Sixteen patients (0.13%) required an unplanned hospital admission, one patient died after
a postprocedural bleeding. The patient was a 69-year-old man receiving palliative care for a
metastasised stomach cancer. This patient underwent PTC for biliary obstruction secondary
to abdominal tumour mass. He was preoperatively noted to have a coagulopathy, for which
he had received vitamin K and thrombocytes. The procedure went uneventful, however,
postprocedural the patient became haemodynamically instable and ultrasound revealed
intra-abdominal bleeding. The PTC drain did not drain any blood. Because of the overall
condition and prognosis of the patient, the team and the patient`s family decided not to
pursue any further interventions, other than ones aimed at patient comfort. The patient
died later that day.
Two patients required resuscitation because of a cardiac arrest, one during asystole,
secondary to pneumatic dilatation of the oesophagus. This patient fully recovered. The
other patient suffered from cardiac arrest secondary to a sheath related air embolus during
pulmonary vein isolation (PVI) on the cardiac catheterisation laboratory. This patient was
left with a permanent neurological deficit. Two patients developed severe haemodynamic
collapse; one due to a cardiac tamponade during PVI, the other due to an anaphylactic
shock secondary to a rupture of an ecchinococcus cyst during a radiological percutaneous
drainage procedure. All four patients were admitted to the intensive care unit after the
procedure. Four patients – intubated during the respiratory event – were admitted to the
recovery ward until extubation (all <6 hours). Eight other patients were admitted to the
hospital for on-going monitoring, one after an anaphylactic reaction after bronchoscopy,
3 with postprocedural hypotension after colonoscopy or ERCP, and 4 patients with
respiratory problems requiring nebulisers and supplemental oxygen after bronchoscopy
or endobronchial ultrasound (EBUS). All were discharged home in good condition the next
day.
DISCUSSION
Our data confirmed our hypothesis that PSA performed by trained SPs results in a low
complication rate for serious AEs of 0.017%. We found an overall incidence of sedation
related AEs defined by the World SIVA reporting tool of 11.7%. The majority could effectively
be treated with minor interventions and did not lead to patient harm. Similar AE rates are
reported in literature.
2-9
Taking into account the higher number of high-risk procedures,
patients with ASA III and IV classifications, the reported incidence of hypoxia
2
is similar to
our hypoxia rate of 5.1%.
The incidence of aspiration during PSAwas 0.06%. None of the patients had a poor outcome.
This is in accordance with previously described outcomes of aspiration in the literature.
7