Patient safety during sedation by anethesia.pptxVIP

Patient safety during sedation by anesthesia professionals during routine upper endoscopy and colonoscopy: an analysis of 1.38 million procedures;Background and Aims: Sedation for GI endoscopy directed by anesthesia professionals (ADS) is used with the intention of improving throughput and patient satisfaction. However, data on its safety are sparse because of the lack of adequately powered, randomized controlled trials comparing it with endoscopist-directed sedation (EDS). This study was intended to determine whether ADS provides a safety advantage when compared with EDS for EGD and colonoscopy. 背景和目的：在胃肠镜过程中让专业麻醉师进行麻醉（ADS）以提高工作量并让患者满意。然而，关于其安全性的证据却极少，因为没有对比内镜医生进行麻醉（EDS）的随机对照实验。本研究旨在研究胃镜、肠镜中ADS比EDS是否具有安全性上的优势。;Methods: This retrospective, nonrandomized, observational cohort study used the Clinical Outcomes Research Initiative National Endoscopic Database, a network of 84 sites in the United States composed of academic, community, health maintenance organization, military, and Veterans Affairs practices. Serious adverse events (SAEs) were defined as any event requiring administration of cardiopulmonary resuscitation, hospital or emergency department admission, administration of rescue/reversal medication, emergency surgery, procedure termination because of an adverse event, intraprocedural adverse events requiring intervention, or blood transfusion. 方法：本研究是回顾性、非随机、观察性队列研究，数据来源于临床结果研究计划国家内镜数据库（该网络由美国84个网点构成，包括大学、社区、保健机构、军队及退伍军人事务部）。严重并发症（SAEs）包括任何需要心肺复苏、住院或急救入院、应用急救药物、急诊手术的情况，以及需要停止内镜的不良事件、术中不良事件需要干预或输血者。;Results: There were 1,388,235 patients in this study that included 880,182 colonoscopy procedures (21% ADS) and 508,053 EGD procedures (23% ADS) between 2002 and 2013. When compared with EDS, the propensity adjusted SAE risk for patients receiving ADS was similar for colonoscopy (OR, .93; 95% CI, .82-1.06) but higher for EGD (OR, 1.33; 95% CI, 1.18-1.50). Additionally, with further stratification by American Society of Anesthesiologists (ASA) class, the use of AD