RESUMO
BACKGROUND: Propofol sedation is effective for gastrointestinal endoscopic procedures, but its narrow therapeutic window highlights the importance of identifying an optimal administration technique regarding effectiveness and safety. This study aimed to determine the incidence of significant adverse events in adult patients scheduled for gastrointestinal endoscopy under anaesthetist-performed sedation using propofol target-controlled infusion and determine the existence of associations between these events and potentially related variables. METHODS: This single-centre, retrospective cohort study took place in a tertiary referral university hospital. Medical records of 823 patients (age > 18 years, American Society of Anesthesiologists physical status classification scores I-III) who had undergone elective gastrointestinal endoscopy under propofol target-controlled infusion sedation during September 2018 were reviewed. Outcomes included hypoxia, hypotension, and bradycardia events, requirement of vasoactive drugs, unplanned tracheal intubation or supraglottic device insertion, and need for advanced cardiac life support. RESULTS: The most frequently encountered adverse event was oxygen desaturation < 95% with an incidence of 22.35%. Vasoactive drug administration, hypotension, and oxygen desaturation < 90% followed, with incidences of 19.2, 12.64, and 9.92%, respectively. Only 0.5% of patients required advanced airway management. Multivariate analysis revealed an association between hypotension events, colonoscopic procedures, and propofol doses (odds ratio: 3.08, 95% confidence interval: 1.43 to 6.61; P = 0.004 and odds ratio: 1.14, 95% confidence interval: 1.00 to 1.29; P = 0.046). A strong dose-effect relationship was found between hypoxia and obesity; patients with body mass index ≥40 were nine times (odds ratio: 10.22, 95% confidence interval: 2.83 to 36.99) more likely to experience oxygen desaturation < 90% events. CONCLUSIONS: Propofol sedation using target-controlled infusion appears to be a safe and effective anaesthetic technique for gastrointestinal endoscopic procedures with acceptable rates of adverse events and could be more widely adopted in clinical practice.
Assuntos
Anestésicos Intravenosos/administração & dosagem , Sedação Profunda/métodos , Sistemas de Liberação de Medicamentos/métodos , Endoscopia Gastrointestinal/métodos , Propofol/administração & dosagem , Idoso , Anestésicos Intravenosos/efeitos adversos , Estudos de Coortes , Endoscopia Gastrointestinal/efeitos adversos , Feminino , Humanos , Hipotensão/induzido quimicamente , Masculino , Pessoa de Meia-Idade , Dor Pós-Operatória/prevenção & controle , Propofol/efeitos adversos , Estudos RetrospectivosRESUMO
BACKGROUND: There are not many studies that address the selection of patients harboring malignant brain tumors for open surgery. It is necessary, especially in developing countries, to establish the standards because of their impact not only on the efficacy but also on the cost-effectiveness of surgery. With the concern to add information that may help in future studies about the decision making, we proposed to analyze factors associated with surgical complications and evaluate their influence on the functional status at 30 days after surgery. METHODS: A consecutive series of 236 surgeries performed between June 1999 and June 2005 were retrospectively analyzed (168 gliomas, 65 metastases, 3 others). Variables evaluated were age, sex, pre- and postoperative KPS, ASA status, anatomic localization, extent of tumor resection, tumor histology, and number of surgeries. RESULTS: The incidence of complicated craniotomies was 15.68% and mortality was 2.97%. Postoperatively, 92% of the patients improved or maintained the functional status, whereas 8% worsened. In multivariate analysis, only preoperative KPS (P = .009), ASA status (P = .02), and histology type (P = .03) showed significant association with postoperative complications. CONCLUSIONS: We found that the neurologic and clinical preoperative condition and grade III gliomas were factors related to postoperative complications, whereas age, extent of resection, and number of surgeries were not risk factors. We believe that these conclusions provide an additional benchmark for future multicentric studies that focus on the selection criteria for resection of malignant brain tumors.