Video Tip: Adverse Events in Luminal Endoscopy | June 2021-Adverse Events in Luminal Endoscopy

Video Transcription

We move now to the complication and the procedures. So, I thought it was interesting to start from the diagnostic procedure, because yes, diagnostic is diagnostic, it's very easy.  Everyone of us can do diagnostic procedure, but still they have some complications, which  are very rare, and the majority of time they're caused by sedation and analgesia. So, usually  those are linked with cardiopulmonary adverse events. So, you have a patient in advanced age most of the time with several comorbidities. So, pulmonary adverse event, they include  hyposemia and hypercapnia, both caused by sedation, which decreases the ventilation, so hypoventilation. And also, the other complication may be aspiration pneumonia. So, many times  I still see colleagues that perform gastroscopy, there is food in the stomach and they carry on performing the gastroscopy. This is not really advisable. One, because, you know,  the food can cover some abnormalities in stomach, and two, because the food can come back in the esophagus and then goes down in the eye waste and this can cause aspiration  pneumonia. So, please, if there is food in the stomach, just stop the procedure, reschedule  for the day after, or if it's an urgent procedure, just give metoclopramide or Domperidone to the patient and repeat the procedure after a few hours.  Cardiac adverse events are hypotension, which is usually caused by the sedation, or hypertension  and vasovagal reaction. Hypertension can be caused by anxiety or by hypotension. And arrhythmias,  someone can think that it's very rare, but actually arrhythmias during the procedure are quite frequent, but they are mostly in keeping with atrial or ventricular ectopic  beats, or atrial fibrillar or supraventricular tachycardia, which is something that resolves spontaneously. Angina, it may happen, very rarely happen, but it happens when you have  reduced myocardial perfusion due to bradycardia or hypotension, but, I mean, you manage the angina with nitroglycerin as usual.

Video Summary

The video discusses complications and procedures related to diagnostic procedures, specifically gastroscopy. Complications are rare but can be caused by sedation and analgesia, resulting in cardiopulmonary adverse events. Pulmonary adverse events include hyposemia, hypercapnia, and aspiration pneumonia. It is advised to reschedule the procedure if there is food in the stomach to avoid potential complications such as covering abnormalities or causing aspiration pneumonia. Cardiac adverse events may include hypotension, hypertension, vasovagal reaction, arrhythmias (atrial or ventricular ectopic beats, atrial fibrillation, supraventricular tachycardia), and angina. Nitroglycerin can be used to manage angina if it occurs. No specific credits were provided in the transcript.

Keywords

complications

procedures

gastroscopy

sedation

analgesia