Impact of propofol infusion-based sedation on anesthesia-related adverse events in endoscopic ultrasonography: A prospective observational study

Procedural sedation is recommended for endoscopic ultrasonography (EUS) to enhance patient comfort and optimize procedural conditions. This study aimed to evaluate the impact of continuous propofol infusion as the main component of the sedation protocol on anesthesia-related adverse events during EUS. This single-center observational prospective cohort study was conducted in the endoscopy unit of a territorial hospital. Seventy-five patients were enrolled from April 24 to June 24, 2024. The sedation protocol included intravenous administration of midazolam (0.02 mg/kg), propofol (0.5 mg/kg), and ketamine (0.25 mg/kg), followed by continuous propofol infusion for anesthesia maintenance. Standard monitoring, the Bispectral Index (BIS), and non-invasive end-tidal CO2 monitoring were applied. Adverse events were defined as arrhythmias, bradycardia (HR <60 bpm), hypotension (SAP <90 mmHg or MAP <60 mmHg), desaturation (SpO2 ≤90%), need for mask ventilation, bleeding, vomiting, unintended movements, coughing during probe insertion, and hiccups. Severe outcomes included death, unplanned endotracheal intubation, or transfer to the intensive care unit (ICU). 87 patients were screened, and 12 were excluded, resulting in a final cohort of 75 patients. The most common indication for EUS was cholecystitis with gallstones. During induction, midazolam (median [IQR]: 2 [1] mg), propofol (80 [53] mg), and ketamine (27.5 [10] mg) were administered. Continuous propofol infusion was administered at a median rate of 6 [1] mg/kg/h. Adverse events included patient movements (34.7%), cough and hiccups (25.3%), hypotension (6.7%), desaturation (14.7%), arrhythmia (10.7%), excessive secretions (13.3%), vomiting (1.3%), and bronchospasm (4%). Body mass index and propofol bolus during induction were identified as independent risk factors for adverse events, with a cutoff propofol dose of 1.15 mg/kg. No severe complications or unplanned ICU transfers occurred. This study reveals the safety of propofol infusion-based sedation during EUS, associated with a low incidence of anesthesia-related adverse events, with no significant cardiopulmonary complications observed.