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Routine Propofol Sedation Increases Risk During Colonoscopy

Summary and Comment |
March 28, 2013

Routine Propofol Sedation Increases Risk During Colonoscopy

  1. Chris E. Forsmark, MD

In a large database study, anesthesia assistance was associated with an elevated risk for perforation, splenic injury, or aspiration pneumonia.

  1. Chris E. Forsmark, MD

The use of anesthesiologist-administered propofol sedation for colonoscopy is increasing in the U.S. (JW Gastroenterol April 13 2012 and JW Gastroenterol Feb 17 2012). Propofol use during colonoscopy is associated with shorter recovery time and higher patient satisfaction but also an estimated 20% increase in health care costs. Whereas most studies on the use of propofol sedation during colonoscopy have focused on its economic cost, researchers now explore another possible disadvantage — increased risk for complications.

Using a database of linked U.S. Medicare and cancer registry data, investigators identified patients without cancer who underwent diagnostic colonoscopy between 2000 and 2009, assessed whether they received anesthesiology services, and determined whether they were hospitalized during the 30 days following colonoscopy for perforation, splenic injury, or aspiration pneumonia. Data on the type of anesthetic agent used were unavailable, but investigators assumed that anesthesiologist-administered propofol was used most often.

Of 165,527 colonoscopy examinations in 100,359 patients, 35,128 procedures (21.2%) were performed with anesthesia assistance. Complications of aspiration, perforation, or splenic injury occurred more frequently in patients who received anesthesia assistance than in those who did not (0.22% vs. 0.16%, P<0.001; odds ratio, 1.46; 95% confidence interval, 1.09–1.94). This difference was mostly attributable to the difference in risk for aspiration (0.14% vs. 0.10%; P=0.02). The risks for perforation and splenic injury were similar between groups. Other independent risk factors for these complications were older age, male sex, increased comorbidity, and undergoing the procedure in a hospital.

Comment

Although the overall rate of complications was very low, the use of anesthesia services for diagnostic colonoscopy resulted in a higher risk for complications. These findings might result in part from confounding if patients who received anesthesia assistance were sicker or more prone to complications and were chosen to receive anesthesia for those reasons. Also, the data were from a period when propofol was sometimes administered by trained nurses rather than anesthesiologists, and the relative safety of this approach compared to anesthesia-administered services cannot be determined. Finally, these findings might be more pronounced in the types of patients included in this trial (≥65 years old), and whether the observed increased risk is present in younger or more healthy patients remains to be determined.

Citation(s):

Reader Comments (3)

H.A, MD Physician, Anesthesiology, New York

Propofol was designed as an induction agent for general anesthesia, not intended as the sole sedation element. It is neither analgesic nor amnestic and requires very deep and therefore potentially dangerous sedation levels to be effective. Using it as the sole agent leads to increased frequency of respiratory and cardiovascular compromise especially in the elderly and obese population alleviated only by the clock. It's use is cavalier and thoughtless, used only in a useless attempt to appear quicker in the eyes of the unknowledgable endoscopist, which it might be only for an anesthesiologist unable to use a balanced technique properly. Complications can always be blamed on any technique but is less likely using drugs specifically designed for specific tasks, i.e. narcotic + benzodiaz + hypnotic.

Cheryl Kee n/a

I recently had a EGD & Colonoscopy done at the same time. I can more then assure you my Doctor is a VERY knowledgable endoscopist and has been doing it for more then 30+ Years. They had to use Propofol with me, Because of a medication I take the normal Versed combo would not have worked with me. So Please don't assume all Doctors are unknowledgable !

John D Woody

Too many assumptions. No real facts! More opinion, than evidence based medicine. Too many unknowns about the numbers. Was Propofol used as the sole agent or other agents included?

Competing interests: None declared

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