How safe is sedated upper gastrointestinal endoscopy in a sub-Saharan teaching hospital?

Abstract

Background: Upper gastrointestinal endoscopy may induce autonomic reactions, with transient changes in haemodynamics and oxygen saturation. We audited the changes in cardiovascular parameters and oxygen saturation during sedated endoscopy.

Patients and Methods: A prospective observational study of 110 consecutive patients scheduled for upper gastrointestinal endoscopy under conscious sedation. The sedative agent, duration of endoscopy, heart rate (HR), systolic blood pressure (SBP), and oxygen saturation (SPO2) were recorded, while the rate pressure product (RPP) was computed. The patient's preoperative anxiety, pain score and discomfort score during the procedure was recorded on a modified visual analogue scale (VAS) rated from 1-10.

Results: Atotal of 110 patients were studied: 69(62.7%) received IV midazolam, and 41(37.3%) had IV pentazocine. The mean HR and RPP increased significantly at all times during the study period from presedation values, p <0.0001. However, the mean HR, SBP and RPP were comparable between midazolam and pentazocine groups. The maximum HR, SBP, RPP in the midazolam group was 155 bpm, 189 mmHg, and 23.35 mmHg/bpm respectively compared to the pentazocine group with 151 bpm, 174mmHg, and 24.71 mmHg/bpm respectively, p <0.05.

Oxygen desaturation (SPO2 ≤ 94%w)as noted in 15 patients (13.6%); midazolam (8.2%) versus pentazocine (5.5%), p =0.82. The lowest SPO2 in midazolam group was 92% versus 93% in pentazocine group. The post endoscopy ECG changes included sinus tachycardia in (12), ST segment elevation (5) and T wave inversion (8) in all patients. The number of patients with pain (VAS >7) during endoscopy was comparable: midazolam (26) versus pentazocine (20), p = 0.25.

Conclusion: Sedationwith either midazolam or pentazocine during endoscopy had similar effects on cardiovascular parameters and oxygen saturation. However, severe pain with VAS >7 was not uncommon.

Keywords: Upper gastrointestinal Endoscopy, midazolam, pentazocine, cardiorespiratory changes, Pain, anxiety score, discomfort score