Anesthesia raises risk of colonoscopy complications

Although the absolute risk is low, use of anesthesia services for colonoscopy is associated with a somewhat higher frequency of aspiration pneumonia and other complications, a recent analysis indicated.

As Gregory S. Cooper, MD, of the University Hospitals Case Medical Center in Cleveland, Ohio, and coauthors noted in their report for JAMA Internal Medicine, colonoscopies traditionally have been performed with conscious sedation, which involves the administration of a benzodiazepine and a narcotic. However, the use of deep sedation with propofol has increased over the past decade. The use of deep sedation for endoscopic procedures has the potential to raise the risk for adverse events.

To study the incidence of these complications, Cooper's group used Medicare data to identify 165,527 colonoscopy procedures completed without polypectomy in 100,359 patients. One-fifth (21.2%, or 35,128) of the procedures involved anesthesia services.

The investigators documented selected postprocedure complications after 284 procedures (0.17%): 173 aspirations, 101 perforations, and 12 splenic injuries. (Some patients had more than one complication.) Overall, complications were more common in cases in which anesthesia was used than in others, at 0.22% vs 0.16%. For example, aspiration was more common when anesthesia was used  (0.14% vs 0.10%). Frequencies of perforation and splenic injury were statistically similar.

Other predictors of complications included age older than 70 years, increasing comorbidity, and performance of the procedure in a hospital setting. The absolute risk of complications was low in colonoscopies with or without anesthesiologist involvement.

Cooper and colleagues concluded that the depth of sedation used for colonoscopy may serve as an independent risk factor for adverse outcomes.

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