Sedierungszwischenfälle: Wie kann man sie effektiv verhindern?

Der Fokus auf die Patientensicherheit war oberstes Gebot bei der Erstellung der S3-Leitlinie zur Sedierung in der gas-trointestinalen Endoskopie [1]. Neben Maßnahmen zur Vermeidung wird auch auf Therapien sedierungsassoziierter Zwischenfälle eingegangen.

Schlüsselwörter:

Endoskopie - Sedierung - Propofol - Benzodiazepine - Monitoring

• Literatur

• 1 Riphaus A, Wehrmann T, Weber B et al. S3-Leitlinie Sedierung in der gastrointestinalen Endoskopie. Z Gastroenterol 2008; 46: 1298-1330
• 2 Quine MA, Bell GD, McCloy RF et al. Prospective audit of upper gastrointestinal endoscopy in two regions of England: safety, staffing, and sedation methods. Gut 1995; 36: 462-467
• 3 Qadeer MA, Vargo JJ, Khandwala F et al. Propofol versus traditional sedative agents for gastrointestinal endoscopy: a meta-analysis. Clin Gastroenterol Hepatol 2005; 3: 1049-1056
• 4 McQuaid KR, Laine L. A systematic review and meta-analysis of randomized, controlled trials of moderate sedation for routine endoscopic procedures. Gastrointest Endosc 2008; 67: 910-923
• 5 Rex DK, Deenadayalu VP, Eid E et al. Endoscopist-directed administration of propofol: a worldwide safety experience. Gastroenterology 2009; 137: 1229-1237
• 6 Lagasse RS. Anesthesia safety: model or myth? A review of the published literature and analysis of current original data. Anesthesiology 2002; 97: 1609-1617
• 7 Jung M, Hofmann C, Kiesslich R et al. Improved sedation in diagnostic and therapeutic ERCP: propofol is an alternative to midazolam. Endoscopy 2000; 32: 233-238
• 8 Wehrmann T, Kokabpick S, Lembcke B et al. Efficacy and safety of intravenous propofol sedation during routine ERCP: a prospective, controlled study. Gastrointest Endosc 1999; 49: 677-683
• 9 Wehrmann T, Grotkamp J, Stergiou N et al. Electroencephalogram monitoring facilitates sedation with propofol for routine ERCP: a randomized, controlled trial. Gastrointest Endosc 2002; 56: 817-824
• 10 Wehrmann T, Riphaus A. Sedation with propofol for interventional endoscopic procedures: A risk factor analysis. Scand J Gastroenterol 2007; 10: 1-7
• 11 Behrens A, Labenz J, Schuler A et al. How safe is sedation in gastrointestinal endoscopy? A multicentre analysis of 388,404 endoscopies and analysis of data from prospective registries of complications managed by members of the Working Group of Leading Hospital Gastroenterologists (ALGK). Z Gastroenterol 2013; 51: 432-436
• 12 Practice guidelines for sedation and analgesia by non-anaesthesiologists: a report by the American Society of Anaesthesiologists Task Force on Sedation and Analgesia by Non-Anaesthesiologists. Anaesthesiology 1996; 84: 459-471
• 13 American Society of Gastrointestinal Endoscopy. Lichtenstein DR, Jagannath S, Baron TH et al. Sedation and anesthesia in GI endoscopy. Gastrointest Endosc 2008; 68: 815-826
• 14 Riphaus A, Rabofski M, Wehrmann T. Endoscopic sedation and monitoring practice in Germany: Results from the first nationwide survey. Z Gastroenterol 2010; 48: 392-397
• 15 Riphaus A, Geist F, Wehrmann T. Endoscopic sedation and monitoring practice in Germany: re-evaluation from the first nationwide survey 3 years after the implementation of an evidence and consent based national guideline. Z Gastroenterol. 2013; 9 Epub 2013 Sep 10
• 16 Qadeer MA, Vargo JJ, Dumot JA et al. Capnographic monitoring of respiratory activity improves safety of sedation for ERCP and EUS. Gastroenterology 2009; 136: 1568-1576
• 17 Beitz A, Riphaus A, Meining A et al. Capnographic monitoring reduces the incidence of arterial oxygen desaturation and hypoxemia during propofol sedation for colonoscopy: a randomized, controlled study (ColoCap Study). Am J Gastroenterol 2012; 107: 1205-1212
• 18 Wehrmann T, Grotkamp J, Stergiou N et al. Electroencephalogram monitoring facilitates sedation with propofol for routine ERCP: a randomized, controlled trial. Gastrointest Endosc 2002; 56: 817-824
• 19 Imagawa A, Fujiki S, Kawahara Y et al. Satisfaction with bispectral index monitoring of propofol-mediated sedation during endoscopic submucosal dissection: a prospective, randomized study. Endoscopy 2008; 40: 905-909
• 20 Al-Sammak Z, Al-Falaki MM, Gamal HM. Predictor of sedation during endoscopic retrograde cholangiopancreatography – bispectral index vs. clinical assessment. Middle East J Anaesthesiol 2005; 18: 141-148
• 21 Müller M, Wehrmann T. Digestion. in press 2014
• 22 Sieg A. Propofol sedation in outpatient colonoscopy by trained practice nurses supervised by the gastroenterologist: a prospective evaluation of over 3000 cases. Z Gastroenterol 2007; 45: 697-701
• 23 Ristikankare M, Julkunen R, Mattila M et al. Conscious sedation and cardiorespiratory safety during colonoscopy. Gastrointest Endosc 2000; 52: 48-54
• 24 Leslie K, Tay T, Neo E. Intravenous fluid to prevent hypotension in pa-tients undergoing elective colonoscopy. Anaesth Intensive Care 2006; 34: 316-321
• 25 Riphaus A, Stergiou N, Wehrmann T. Sedation with propofol for routine ERCP in high-risk octogenarians: a randomized, controlled study. Am J Gastroenterol 2005; 100: 1957-1963
• 26 Deutscher Rat für Wiederbelebung - German Resuscitation Council e.V. Im Internet: http://www.grc-org.de Stand 02.04.2014
• 27 Bhalla A, Sood A, Sachdeva A. et al. Cardiorespiratory compromise under conscious sedation during upper gastrointestinal endoscopy. J Coll Physicians Surg Pak 2006; 16: 585-589
• 28 Lewalter T, Lickfett L, Schwab JO et al. Notfall Herzrhythmusstörungen. Dtsch Ärztebl 2007; 104: 997-997
• 29 American Society of Anesthesiology. Gross JB, Farmington CT, Bailey PL et al. Practice guidelines for sedation and analgesia by non-anesthsiologists. Anesthesiology 2002; 96: 1004-1017
• 30 Willey J, Vargo JJ, Connor JT et al. Quantitative assessment of psychomotor recovery after sedation and analgesia for outpatient EGD. Gastrointest Endosc 2002; 56: 810-816
• 31 Horiuchi A, Nakayama Y, Katsuyama Y et al. Safety and driving ability following low-dose propofol sedation. Digestion 2008; 78: 190-194
• 32 Horiuchi A, Nakayama Y, Fujii H et al. Psychomotor recovery and blood propofol level in colonoscopy when using propofol sedation. Gastrointest Endosc 2012; 75: 506-512