The Calm Before the Scope: A Look at Sedation Methods for Patients with History of Atrial Fibrillation Undergoing Screening Colonoscopy

Document Type

Conference Proceeding

Publication Date

10-25-2023

Publication Title

Am J Gastroenterol

Abstract

Introduction: Anesthesia/Sedation is an essential part of any endoscopic procedure. Main sedation types used in endoscopy are Conscious Sedation (CS) which uses IV analgesics & anxiolytic & can be given by the endoscopist or Deep sedation (General Anesthesia or Moderate Anesthesia Care (MAC)). MAC uses propofol administered by anesthesia team to achieve deep sedation. Afib is the most common chronic arrhythmia that is seen in patients undergoing endoscopy and can carry a higher risk of certain periprocedural cardiopulmonary complications. Methods: This is a retrospective single-center study at a tertiary hospital and multiple affiliated ambulatory endoscopy sites. A sample of patients older than 18 years, has Afib, & had colonoscopy between 1/2014 - 9/2020 was included. Data on baseline characteristics, Afib type, medications, sedation type, clinical outcomes, & complications were collected. Results: A total 586 patients were included (mean 68.7 years, SD 9.7 years), of which 318 (57.8%) were males. 385 (65.7%) patients received CS at one of the ambulatory sites, and 201 (34.3%) received MAC at a hospital-based setting. Paroxysmal Afib was the most common type (70.8%), with CHADS2VASC score mean (2.9, SD 1.6). 238 were on DOAC (40.7%), 181 were on warfarin (30.9%). 376 (64.2%) patients were on beta blockers for rate control. Comparison analysis comparing CS and MAC showed longer sedation time in CS (55.3 vs 52.6 minutes, P< 0.026), while a higher risk of RVR noted in MAC (3% vs. 0.5%; P=0.022), but comparing bradycardia and hypoxia showed no statistically significant difference between CS & MAC (P=0.059, P=1.00) respectively. Also noted that those who are rate controlled had lower complication rates (14.3% vs. 25.6%, P=0.003). Multivariable logistic regression modeling indicates that the MAC and CS showed no statistically significant complications after accounting for the other study variables including age, sex, Afib type, anticoagulation use or type, rate control medications, CHADS2VASC score, ASA rating (Figure 1, Table 1). Conclusion: In our study, patient with Afib who underwent screening colonoscopy with CS vs MAC showed comparable cardiopulomnary safety profile if not safer. There was no statistically significant risk for hypoxia and bradycardia, while MAC showed higher risk for RVR (tachycardia) compared to CS. Longer sedation time in CS compared to MAC are likely related to induction time. Larger scale randomized controlled trial needed to study safety CS compared to MAC in Afib patients undergoing endoscopy.

Volume

118

Issue

10

First Page

S560

Last Page

S561

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