Safety Of Propofol/Midazolam Sedation For Upper Gastrointestinal Endoscopy In Patients With Co-Morbidities

Propofol sedation has been increasingly applied in upper gastrointestinal (GI) endoscopy, but its application in patients with co-morbidities needs deep investigation. The aim of the present study was to explore the safety of propofol/midazolam sedation for upper gastrointestinal endoscopy in patients with co-morbidities. Collected data from 96,583 patients who underwent sedative upper GI endoscopy with propofol and midazolam were analyzed. Saturation of peripheral oxygen, blood pressure, and pulse rate were monitored, and patient discomfort, adverse events, drug dosages, and recovery time were recorded. The occurrence rates of hypoxemia, hypotension, hypertension, tachycardia, bradycardia, and arrhythmia were 0.888%, 0.243%, 0.019%, 0.277%, 0.286%, and 0.006%, respectively. Reductions in blood pressure and pulse rate were transient, requiring no treatment, and values returned to normal rapidly after endoscopic procedures. The overall rate of adverse events and that of hypoxemia were associated with age, weight, alcohol consumption, smoking, American Society of Anesthesiology (ASA) physical status, co-morbidities and sedation method. These rates were higher in patients with cardiovascular, respiratory, or hepatic disease, sleep apnea, or severe anemia than in patients without co-morbidities (P < 0.005), and the rates were significantly higher with continuous sedation than with stepwise sedation (P < 0.005). The administration of propofol combined with midazolam for upper GI endoscopy is practicable and safe, but patients with cardiovascular, respiratory, or hepatic disease, sleep apnea, or severe anemia are more likely to experience decreased SpO(2). Stepwise sedation can reduce the drug dosage, incidence of hypoxemia and overall rate of adverse events.