摘要
Background and aims:Open-access scheduling is highly utilized for facilitating generally low-risk endoscopies.Preprocedural screening addresses sedation requirements;however,procedural safety may be compromised if screening is inaccurate.We sought to determine the reliability of our open-access scheduling system for appropriate use of conscious sedation.Methods:We prospectively and consecutively enrolled outpatient procedures booked at an academic center by open-access using screening after in-office gastroenterology(GI)consultation.We collected the cases inappropriately booked for conscious sedation and compared the characteristics for significant differences.Results:A total of 8063 outpatients were scheduled for procedures with conscious sedation,and 5959 were booked with open-access.Only 78 patients(0.97%,78/8063)were identified as subsequently needing anesthesiologist-assisted sedation;44(56.4%,44/78)were booked through open-access,of which chronic opioid(47.7%,21/44)or benzodiazepine use(34.1%,15/44)were the most common reasons for needing anesthesiologist-assisted sedation.Patients on chronic benzodiazepines required more midazolam than those not on chronic benzodiazepines(P=0.03)of those patients who underwent conscious sedation.Similarly,patients with chronic opioid use required more fentanyl than those without chronic opioid use(P=0.04).Advanced liver disease and alcohol use were common reasons for patients being booked after in-office consultation and were significantly higher than those booked with open-access(both P<0.01).Conclusions:We observed that the majority of patients can be triaged for conscious sedation using a multi-tiered screening process.Importantly,few patients(<1.0%)were inappropriately booked for conscious sedation.The most common reasons for considering anesthesiologist-assisted sedation were chronic opioid,benzodiazepine and/or alcohol use and advanced liver disease.This suggests that these entities could be included in screening processes for open-access scheduling.
背景与目的:开放获取内镜筛查能很好地应用于普通低风险的内镜操作。内镜操作前的筛查重点是镇静需求,但筛查结果欠准确将有损内镜的安全性。本研究旨在论证我们的开放获取内镜筛查系统能否准确筛选出可清醒镇静的病例。方法:前瞻性连续入组经开放获取筛查系统或在胃肠科办公室咨询后进行预约的门诊内镜操作病例。收集错误预约为清醒镇静的病例,对其病例特征进行分析。结果:共计有8063例门诊病例预约行清醒镇静状态下的内镜操作,其中5959例通过开放获取系统进行预约。仅78例(0.97%,78/8063)后续被认为需要麻醉医生支持下的镇静处理,其中44例(56.4%,44/78)是通过开放获取筛查系统预约的,长期服用鸦片(47.7%,21/44)和苯二氮(34.1%,15/44)是需要麻醉医生支持镇静的主要原因。长期服用苯二氮者较未服用者在清醒镇静时需要更高剂量的咪达唑仑(P=0.03),长期服用鸦片者镇静时则需要更高剂量的芬太尼(P=0.04)。进展期肝病和长期饮酒是胃肠科办公室咨询后预约病例需要麻醉医生支持镇静的常见原因,其所占比例明显高于开放获取筛查系统预约病例(均P<0.01)。结论:我们观察到经过多层筛查,绝大多数病例都适合于清醒镇静,更重要的是,只有很少一部分(<1.0%)病例清醒镇静预约不当。需要麻醉医生辅助镇静的主要原因包括鸦片和苯二氮的长期服用和/或长期饮酒和进展期肝病,提示这些病例应纳入开放获取筛查系统中。
