Anesthesia for Gastrointestinal Endoscopy from in Siriraj Hospital : A Prospective Study

Transcription

1 Anesthesia for Gastrointestinal Endoscopy from in Siriraj Hospital : A Prospective Study Somchai Amornyotin M.D.,* Tharnthip Pranootnarabhal M.D.,* Viyada Chalayonnavin BN.,* Siriporn Kongplay BN.* àõ : Àâ ß «Ÿâ À µ «àõß âõß ß πõ À π ßæ» µ Èß µàªï æ.» :» ª â ßÀπâ Õ π æ..,* æ å ª ÿ π æ æ..,* «ππ «π æ..,*» æ ßæ æ..* * «««æ» µ å» æ À «À ÿß æœ π µ «àõß âõß ß πõ À ªìπÀ µ π Àπ Ëß À µ ««π «º ª µ Õß ß πõ À Ëπ πõ à ß æ àà» π È ªìπ ««âõ Ÿ Ë «Àâ ß «Ÿâ «µ ÿª ß å æ ËÕ» Àâ ß «Ÿâ Ë â «âõπµà ß Ê Ë Èπ Ë «âõß Àâ ß «Ÿâ » ºŸâªÉ«Ë Àâ ß «Ÿâ À µ «àõß âõß ß πõ À π ßæ» µ Èß µà Õπµÿ æ.» π π æ.» ««âõ Ÿ Ë«ª ÕߺŸâªÉ«ªí À àõπ Àâ ß «Ÿâ «Àâ ß «Ÿâ Ë â «Àâ ß «Ÿâ π Õß À µ «âõπ ª «ÿªº â µ ßæ π º» ºŸâªÉ«ÈßÀ 7,854 À µ 8,589 Èß ªìπ esophagogastroduo- denoscopy (53.9%), colonoscopy (28.2%), endoscopic retrograde cholangiopancreatography (9.6%), sigmoidoscopy (4.0%), proctoscopy (1.9%) Õ Ëπ Ê ºŸâªÉ«Õ ÿ À«à ß ªï æ Ë ÿ (22.8%) à«π ASA class II (45.6%) «π Õ dyspepsia (19.8%), upper gastrointestinal hemorrhage (14.0%), CA colon (7.2%), gastritis (6.0%), bowel habbit change (5.6%), lower gastrointestinal hemorrhage (4.5%) Õ Ëπ Ê æ «à «π À µ Ÿß (24.7%), Õ (15.7%), À«π (14.9%) ß À «À Õ Õ (10.8%) ªìπªí À àõπ Àâ ß «Ÿâ Àâ ß «Ÿâ à«π À à â«topical pharyngeal anesthesia (52.0%) intravenous sedation (39.5%) ºŸâªÉ«à«π â lidocaine, propofol, fentanyl midazolam «Àâ ß «Ÿâ µ Èß µà π «âõπ Ëæ àõ Ë ÿ Õ «π Õ µë ÿª Àâ ß «Ÿâ À µ «àõß âõß ß πõ À âõ à ß ª æ â«â æ Ë â ß «Ÿâ ßÀ Õ Õ à ªìπµâÕß â À Õ π æ» Õ Ëπ Ê µàºÿâ Àâ ß «Ÿâ ««ß «âõπµà ß Ê ËÕ Èπ Thai J Anesthesiology 2007 ; 33(2) : *Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University 93

2 Gastrointestinal endoscopy is one of the most common interventional medical procedures performed throughout the world. With the increasing safety of endoscopy, both upper and lower gastrointestinal endoscopy are being advocated as first-line screening choices. This would result in approximately 15% of the United States population undergoing upper gastrointestinal endoscopy per year. 1 Sedation is usually administered to facilitate endoscopy ; however, the details of sedation practice vary considerably between endoscopists, between hospitals and between countries. 2 Unsedated endoscopy is being investigated for its role in selected cases, but appears to remain an unattractive alternative for most patients. 3 Siriraj hospital has performed gastrointestinal (GI) endoscopy since Most of the procedure are performed by endoscopists under anesthesia. The choices and techniques of anesthesia and drug selection vary according to the condition of the patients, familiarity of the anesthesiologists and satisfaction of the endoscopists. Little is known about how practices in anesthesia as well as monitoring during GI endoscopy. Moreover, the complication rates of anesthesia have changed over time. The aim of this study was to report and evaluate the choices and techniques, drug usage and complications which occurred during that period of time. Furthermore this prospective study was performed in order to adapt and keep data for further research in the near future. Material and Method Data were reviewed from anesthetic, procedure records and history charts of patients who underwent GI endoscopy during a period from October 1, st 2005 to September 30, th 2006 at Siriraj GI Endoscopy Center, In the Horner of Professor Vikit Viranuvatti, Faculty of Medicine Siriraj Hospital, Mahidol University. The general data included sex, age, ASA physical status, diagnosis and GI endoscopic procedures. The anesthetic data encompassed preanesthetic problems, choice of anesthesia, variety of drug usage, time spent, monitoring and intraoperative complications. Results were reported as mean and standard deviation (SD) or percentage (%) when appropriate. Results There were 7,854 cases and 8,589 GI endoscopic procedures preformed during the study period. The majority of the patients were female with ASA physical status I-II. The mean age was 56.1 ± 16.7 years. About 22.8% of them were in the age group of years old (Table 1). The diagnoses were dyspepsia (19.8%), upper Table 1 Patientsʼ characteristics Characteristics Number (%) Sex Male 3,839 (48.9) Female 4,015 (51.1) Age (yrs) < (0.7) (1.4) (5.6) (9.7) ,419 (18.1) ,789 (22.8) ,569 (20.0) ,267 (16.1) (5.1) > (0.5) Mean age ± SD 56.1 ± 16.7 ASA physical status I 2,544 (32.4) II 3,585 (45.6) III 1,657 (21.1) IV 68 (0.9) 94 «ªï Ë 33 Ë 2 π- ÿπ π 2550

3 gastrointestinal hemorrhage (14.0%), CA colon (7.2%), gastritis (6.0%) bowel habit change (5.6%) and lower gastrointestinal hemorrhage (4.5%), (Table 2). The majority of cases presented with pre-anesthetic medical problems, as shown in Table 3. They involved mainly hypertension (24.7%), hematologic diseases including anemia (15.7%), diabetes mellitus (14.9%) and cardiovascular diseases including coronary artery disease and valvular heart diseases (10.8%). Other problems were Table 2 Diagnoses Number (%) Dyspepsia 1,554 (19.8) Upper gastrointestinal hemorrhage 1,103 (14.0) CA colon 569 (7.2) Gastritis 471 (6.0) Bowel habbit change 442 (5.6) Lower gastrointestinal hemorrhage 357 (4.5) Cirrhosis 249 (3.2) Peptic ulcer 196 (2.5) Check up 162 (2.1) CBD stone 160 (2.0) Gastro-esophageal reflux disease 157 (2.0) Abdominal pain 157 (2.0) Esophageal varice 149 (1.9) CA stomach 131 (1.7) Esophageal stricture 131 (1.7) CA esophagus 125 (1.6) Cholangiocarcinoma 104 (1.3) Obstructive jaundice 101 (1.3) Hepatocellular carcinoma 89 (1.1) CA pancrease 77 (1.0) Chronic constipation 68 (0.9) Corrosive esophagitis 68 (0.9) Others 1,234 (15.7) Table 3 Preanesthetic problems Number (%) Hypertension 1,431 (24.7) Hematologic disease 911 (15.7) Diabetes mellitus 862 (14.9) Cardiovascular disease 623 (10.8) Liver disease 443 (7.7) Electrolyte imbalance 393 (6.8) Respiratory disease 259 (4.5) CNS disease 232 (4.0) Renal disease 210 (3.6) Dyslipidemia 81 (1.4) Thyroid disease 75 (1.3) Others 265 (4.6) liver diseases ; hepatitis, cirrhosis, electrolyte imbalances, respiratory diseases ; chronic obstructive pulmonary diseases, asthma, central nervous system diseases ; CVA, epilepsy, renal diseases ; chronic renal failure, dyslipidemia, thyroid diseases ; hyper/hypothyroidism and others. Table 4 shows the endoscopic procedures, i.e. esophagogastroduodenoscopy (53.9%), colonoscopy (28.2%), endoscopic retrograde cholangio-pancreatography (9.6%), sigmoidoscopy (4.0%), proctoscopy (1.9%) and others. Almost all of the procedures were carried out under topical pharyngeal anesthesia (52.0%), intravenous sedation (39.5%), general anesthesia with either endotracheal tube insertion (2.3%) or tracheostomy tube (0.4%) and others (5.8%). The details of sedative agents, narcotics, muscle relaxants, inhalation agents and local anesthetic are shown in Table 5. Clinical monitoring observed by the anesthetic personnel consisted of non-invasive blood pressure, pulse oxymetry, electrocardiography, fluid intake and output. The anesthetic duration ranged from 5 to 210 minutes. Vol. 33, No. 2, April-June 2007 Thai Journal of Anesthesiology 95

4 Table 4 Procedures Procedure Number (%) Esophagogastroduodenoscopy (EGD) 4,629 (53.9) Colonoscopy 2,422 (28.2) Endoscopic retrograde cholangio-pancreatography (ERCP) 824 (9.6) Sigmoidoscopy 344 (4.0) Proctoscopy 163 (1.9) Endoscopic ultrasonography (EUS) 86 (1.0) Dilate esophagus 30 (0.3) Percutaneous endoscopic gastrostomy (PEG) 27 (0.3) Colonic stent 18 (0.2) Esophageal stent 14 (0.2) Others 32 (0.4) Table 5 Anesthesia related data Data Number (%) Anesthetic technique Topical pharyngeal anesthesia 4,410 (52.0) Intravenous sedation 3,349 (39.5) General anesthesia with endotracheal tube 196 (2.3) General anesthesia with tracheostomy tube 34 (0.4) Others 492 (5.8) Sedative agents Propofol 2,995 (83.7) Midazolam 2,882 (80.5) Ketamine 127 (3.5) Thiopental 39 (1.1) Narcotics Fentanyl 2,988 (83.5) Pethidine 573 (16.0) Muscle relaxants Atracurium 136 (59.1) Vecuronium 94 (40.9) Succinylcholine 128 (55.7) Inhalation agents Sevoflurane 171 (74.3) Isoflurane 59 (25.7) Local anesthetics Lidocaine spray 2,994 (67.9) Lidocaine viscous 1,899 (43.1) 96 «ªï Ë 33 Ë 2 π- ÿπ π 2550

5 No serious anesthetic complication occurred during the study. The overall complication rate was 31.2%. The majority of complications were cardiopulmonary in nature and were related to sedation and analgesia. Hypotension (13.8%) which was promptly corrected by the administration of vasopressor and fluid loading was the most frequent anesthetic complication. Other complications were hypertension (7.8%) and tachycardia (7.3%). Discussion Gastrointestinal (GI) endoscopy is a common and essential examination to detect GI cancer. Properly performed, it provides valuable information in patients with GI conditions. Additionally, therapeutic GI endoscopy forms the mainstay of treatment for GI bleeding and for dilation or stenting of benign and malignant strictures. However, endoscopy is generally denied by the patient because of anxiety and severe discomfort. The technology of endoscopy has been improved over the past 20 years and the methods of premedication have been changed as well. Sedative premedication has been used to settle patient anxiety and reduce the discomfort and unpleasantness during the insertion of the endoscopy. Moreover, this premedication can reduce the fear of the test by inducing amnesia so that the patients can undergo the endoscopy in a comfortable state. The role of sedation during GI endoscopy is a topic of continuing debate. 4 While there is evidence that many endoscopic procedures can be safely performed without sedation or with pharyngeal anesthesia alone, many endoscopists feel that, given the choice, patients generally wish to be sedated during the whole procedure. 5-7 Although the use of sedation during endoscopy is thought to be widely accepted, data from different studies indicate that patterns of use of premedication may largely depend on cultural, or even regional and local differences. 8,9 Up to 50% of morbidity and mortality during endoscopic procedures, 4 as well as equipment and labor costs, are related to sedation. 10 Periodic evaluation of the standard sedation practices of endoscopists is thus essential. In fact, the data used to assess the global risk of sedation during endoscopy were derived mainly from large studies conducted in the early 1990s 11 : these demonstrated serious cardiorespiratory complications up to 0.54% of patients 12 and a mortality rate of 0.05%. 11 The attitude of patients and of physicians to sedation is likely to change over time, for a number of reasons. 9 The proper administration of sedation and analgesia for endoscopic procedures is as much as art as science and as essential to the successful procedure as skillful maneuvering of the insertion tube. In recent years, a great deal of attention has been given to sedation and analgesia practice by endoscopists, both by gastroenterology and anesthesiology professional societies. 13 Despite the established nature of the current practice of sedation and analgesia, numerous case series, prospective trials, and practice guidelines and position statements recently have been published on this topic. This must reflect some level of dissatisfaction or concern with the status quo. Indeed, there are concerns about our practice of sedation and analgesia, involving issues of patient satisfaction, safety, and cost. Sedation and analgesia for endoscopy is intended to provide moderate sedation as defined by the American Society of Anesthesiologists (ASA), where the patient can provide a purposeful response to verbal or tactile stimulation (not simply withdrawal to a sternal rub or pinch), has adequate ventilation and cardiovascular function, and needs no intervention to the airway. However, the ASA has recognized that sedation and analgesia provided by someone other than an anesthesiologist is often deep sedation, where patient response is only to repeated or painful stimulation, spontaneous ventilation may be inadequate, and airway intervention, may be required. The leadership of our gastroenterology and anesthesiology professional societies would better serve their members and our patients by cooperating to improve fundamental training in sedation and analgesia and management of its complications for practicing gastroenterologists Vol. 33, No. 2, April-June 2007 Thai Journal of Anesthesiology 97

6 and trainees alike, and to desist from the exchange of confliction and often counterproductive position statements on practice issues, as we have seen in the recent past. An increasing number of gastroenterologists use other professionals, such as anesthesiologists or nurse anesthetists, to provide sedation and analgesia and to monitor the patient. 14 This strategy addresses the safety concerns listed earlier, undoubtedly provides high patient satisfaction, improves productivity by increasing the time available for the procedure itself, and decreases recovery bed turnaround time because agents such as propofol will be used routinely. Although this practice is beneficial to the individual gastroenterologist, its impact on our specialty as a whole remains to be seen. Procedure costs will be increased significantly, and an attempt to shift these costs to third-party payers and patients may be resisted. The differences in usage of intravenous sedation between different countries have been attributed to cultural differences. Thailand has traditionally been counted among the countries where sedation was used rarely, in contrast to the United States or Great Britain. The facility to offer a smooth endoscopy under sedation may afford some gastroenterologists an advantage in a field in which there is an element of increasing economic competition. As expected, the commonly used sedative drug is midazolam, usually used alone for EGD and in combination with an opioid for colonoscopy. The use of propofol for endoscopy is a topic of ongoing discussion. In our view, the anesthesiologists had been actively supported during the procedure. In common with other clinicians, the authors believe that this sedation requires specific training and experience and should be strictly introduced only under optimal conditions. 15 These include an atmosphere of cooperation and practical support in the handing of drug administration, and in the detection and management of impaired ventilation. With the advent of small caliber endoscopes, much interest has focused on performing endoscopy without sedation, as this removes the need for the recovery of patients after their procedure, potentially accelerating throughout and saving money. However, patient and endoscopist acceptance of unsedated endoscopy varies widely, and investigators have reported difficulty in recruiting patients to trials of unsedated endoscopy. 16 Some previous studies have shown that 10-20% of patients cross over from unsedated to receiving sedation during the procedure, 17 whereas other studies report cross-over rates of up to 80% during unsedated endoscopy. 16,18 A factor increasing tolerance in the previous studies was the caliber of the endoscopy. Whether or not a patient is sedated appears to affect the success rate of the procedure. In one study, successful endoscopy rates were lower in unsedated patients (success rate 76% in the sedation group versus 46% in the no sedation group) 17 and with no evidence of an increase in safety. In that recent double-blind, randomized trial of sedation versus placebo for gastroscopy, satisfac-tion and willingness to repeat the procedure were high in the sedated group. 17 Ten percent of the placebo group crossed over to sedated group. Patient satisfaction was low in the placebo group (79 versus 47%). The survey on endoscopic complications conducted by the American Society for Gastrointestinal Endoscopy (ASGE) in found an overall complication rate of 0.13% for diagnostic upper endoscopy, with a mortality rate of 0.004%. The majority of complications (46%) were cardiopulmonary in nature and were related to sedation and analgesia. The same survey also provided complication rates for diagnostic colonoscopy (perforation 0.2%, bleeding 0.09%, overall 0.35%), and colonoscopy with polypectomy (perforation 0.32%, bleeding 1.7%, overall 2.3%), among other procedures. Subsequent surveys and database reviews have yielded similar results. 20 The limitation of these surveys and retrospective analyses have been widely acknowledged by their investigators and others, and include reporting and selection biases and incomplete follow-up data. Studies that rely on voluntary reporting typically underestimate actual complication rates «ªï Ë 33 Ë 2 π- ÿπ π 2550

7 Over the years, the patients also have changed. We are increasingly seeing patients at the extremes of health status : perfectly healthy individuals who undergo a screening procedure and, at the other extreme, patients with a multitude of comorbid problems who are undergoing endoscopy for serious, potentially life-threatening disorders, such as active bleeding and complex biliary problems. In addition, the spectrum of comorbid condition is changing. The proportion of the population that is significantly overweight has increased ; many have sleep apnea. Complications of bariatric surgery or laparoscopic interventions, heretofore rare, are further examples of an evolving and expanding patient base for GI endoscopy. Lastly, new techniques have expaned the indications of GI endoscopy and bring an entirely new variety of adverse events. Gangi S., et al. found that complications occurred 2 to 70 times more commonly than previously reported. They speculate that many of these differences may be because of inclusion of more severely ill patients, because their study was hospital based, and/or that previous studies may have underestimated the risk because of inherent reporting bias on questionnaires and to ascertainment bias consequent to the more limited follow-up available for outpatients. They acknowledge that study has certain limitations. For example, the procedures included in the analysis were performed on inpatients and hospital outpatients. These two groups may have probabilities for cardiovascular complications that are markedly different. In addition, potentially important charges (e.g., for dopamine, beta blockers, or intravenous administration of fluids for hypotension) were not captured, thus raising the possibility that the occurrence of cardiovascular events was underestimated. Nevertheless, this study clearly suggests that cardiovascular complications may be significantly more frequent in patients who undergo GI endoscopy in the hospital. In Siriraj Hospital, there was no serious anesthesia complication occurred during this study. However, there were four serious procedural complications (0.05%). All of them were colonic perforations. The main limitation of this study is its reliance on self-reported data. There is no way of knowing whether data could have the conclusion of this report. Furthermore, it can be argued that self-reporting may tend toward an underestimation of unpleasant data. On the other hand, the reported incidence of adverse events correlated quite well with the historical data and with the results of two prospectively conducted local database studies. 22 The authors therefore assume that the data are realistic and reflect daily clinical practice. While an audit of medical records would have provided more objective results, such a methodical procedure is not practicable if data are to be derived from individual private practices as well as from the databases of hospital departments or managed-case organisations. Conclusion Gastrointestinal endoscopy is a procedure for diagnosis and treatment of GI abnormalities. This study has highlighted on anesthesia. Unsedated endoscopy may arguably offer economic advantages, but it remains an unpopular option with patients, and may result in less satisfactory examinations. Anesthesia and sedation by anesthetic personnel appear to be safe. There was no need for special techniques or drugs in anesthesia. However, clinical signs should be carefully observed and the anesthetic personnel had to optimize the patientʼs condition for safety and beware of complications. Acknowledgments The authors would like to thank all of the staff at the study site for their valuable contribution to the study and are grateful to Professor Ungkab Prakanrattana, Chairman of Department of Anesthesiology, Faculty of Medicine Siriraj Hospital for her helpful suggestions. References 1. Wolfsen HC, Hemminger LL, Achem RR, et al. Complications of endoscopy of the upper gastrointestinal tracts a single-center experience. Mayo Clin Proc 2004 ; 79 : Vol. 33, No. 2, April-June 2007 Thai Journal of Anesthesiology 99

8 2. Waye JD. Worldwide use of sedation and analgesia for upper intestinal endoscopy. Gastrointest Endosc 1999 ; 50 : Madan A, Minocha A. Who is willing to undergo endoscopy without sedation : patients, nurses, or the physicians? South Med J 2004 ; 97 : Bell GD. Preparation, premedication, and surveillance. Endoscopy 2004 ; 36 : Abraham N, Barkun A, Larocque M, et al. Predicting which patients can undergo upper endoscopy comfortable without conscious sedation. Gastroiutest Endosc 2002 ; 56 : Thanvi BR, Munshi SK, Vijayakumar N, et al. Acceptability of esophagogastroduodenoscopy without intravenous sedation : patientsʼ versus endoscopistʼs perception with special reference to older patients. Postgrad Med J 2003 ; 79 : Heuss LT, Drewe J, Schneiper P, et al. Patient-controlled vs. nurse-administered sedation with propofol during colonoscopy : a prospective randomized trial. Am J Gastroenterol 2004 ; 99 : Lazzaroni M, Porro GB. Preparation, premedication, and surveillance. Endoscopy 2001 ; 33 : Mulcahy HE, Hennessy E, Connor P, et al. Changing patterns of sedation use for routine outpatient diagnostic gastroscopy between 1989 and Aliment Pharmacol Ther 2001 ; 15 : Mokhashi MS, Hawes RH. Struggling toward easier endoscopy. Gastrointest Endosc 1998 ; 48 : Quine MA, Bell GD, McCloy RF, et al. Prospective audit of upper gastrointestinal endoscopy in two regions of England : safety, staffing, and sedation method. Gut 1995 ; 36 : Arrowsmith JB, Gerstman BB, Fleischer DE, Benjamin SB. Results from the American Society for Gastrointestinal Endoscopy/U.S. Food and Drug Administration collaborative study on complication rates and drug use during gastrointestinal endoscopy. Gastrointest Endosc 1991 ; 37 : Waring JP, Baron TH, Hirota WK, et al. Guidelines for conscious sedation and monitoring during gastrointestinal endoscopy. Gastrointest Endosc 2003 ; 58 : Faulx AL, Vela S, Das A, et al. The changing landscape of practice patterns regarding unsedated endoscopy and propofol use : a national web survey. Gastrointest Endosc 2005 ; 62 : Chutkan R, Cohen J, Abedi M, et al. Training guideline for use of propofol in gastrointestinal endoscopy. Gastrointest Endosc 2004 ; 60 : Birkner B, Fritz N, Schatke W, Hasford J. A prospective randomized comparison of unsedated ultrathin versus standard esophagogastroduodenoscopy in routine outpatient gastroenterology practice : does it work better through the nose? Endoscopy 2003 ; 35 : Abraham NS, Fallone CA, Mayrand S, et al. Sedation versus no sedation in the performance of diagnostic upper gastrointestinal endoscopy : a Canadian randomized controlled cost-outcome study. Am J Gastroenterol 2004 ; 99 : Preiss C, Charton JP, Schumacher B, Neuhaus H. A randomized trial of unsedated transnasal small-calibre esophagogastroduodenoscopy (EGD) versus peroral smallcalibre EGD versus conventional EGD. Endoscopy 2003 ; 35 : Silvis SE, Nebel O, Rogers G, Sugawa C, Mandelstam P. Endoscopic complications. Results of the 1974 American Society for Gastrointestinal Endoscopy Survey. JAMA 1976 ; 235 : Sieg A, Hachmoeller-Eisenbach U, Eisenbach T. Prospective evaluation of complications in outpatient GI endoscopy : a survey among German gastroenterologists. Gastrointest Endosc 2001 ; 53 : Zubarik R, Fleischer DE, Mastropietro C, Lopez J, Carroll J, Benjamin S. Prospective analysis of complications 30 days after outpatient colonoscopy. Gastrointest Endosc 2000 ; 52 : Kulling D, Rothenbuhler R, Inauen W. Safety of nonanesthetist sedation with propofol for outpatient colonoscopy and esophagogastroduodenoscopy. Endoscopy 2003 ; 35 : «ªï Ë 33 Ë 2 π- ÿπ π 2550

9 Anesthesia for Gastrointestinal Endoscopy from in Siriraj Hospital : A Prospective Study Abstract Background : Gastrointestinal endoscopy is a procedure for diagnosis and treatment of GI abnormalities. It is one of the most common interventional medical procedures performed throughout the world. The authors studied anesthetic data as a basis for further research. Objective : To report and evaluate the choices and techniques, drug usuage and complications of anesthesia for GI endoscopy from in Siriraj Hospital. Method : Prospectively analyzed the patients on whom GI endoscopy had been performed during the period of October, 2005 to September, 2006 in Siriraj GI Endoscopy Center. The patientsʼ characteristics, preanesthetic problems, anesthetic techniques, agents, time, and complications, as well as endoscopic procedures were assessed and summarized by using descriptive statistics. Results : During the study period there were 7,854 cases and 8,589 endoscopic procedures ; i.e. esophagogastroduodenoscopy (53.9%), colonoscopy (28.2%), endoscopic retrograde cholangiopancreatography (9.6%), sigmoidoscopy (4.0%), proctoscopy (1.9%) and others. The majority of them were in the age group of years (22.8%) and classified in ASA class II (45.6%). The diagnosis were dyspepsia (19.8%), upper gastrointestinal hemorrhage (14.0%), CA colon (7.2%), gastritis (6.0%), bowel habit change (5.6%), lower gastrointestinal hemorrhage (4.5%) and others. Most common preanesthetic problems were hypertension (24.7%), hematologic disease (15.7%), diabetes mellitus (14.9%) and cardiovascular disease (10.8%). Topical pharyngeal anesthesia (52.0%) and intravenous sedation (39.5%) were the main anesthetic techniques. The mainly used anesthetic agents were lidocaine, propofol, fentanyl and midazolam. The anesthetic duration ranged from 5 to 210 minutes. The overall complication rate was 31.2%. Hypotension (13.8%) was the most frequent anesthetic complication. Conclusion : Almost all of the GI endoscopic procedures, topical anesthesia and intravenous sedation can be used effectively. However, clinical signs should be carefully observed and the anesthetic personnel had to optimize the patientʼs condition for safety and beware of complications. Keywords : Gastrointestinal endoscopy, Anesthetic management, Anesthetic technique, Complication Vol. 33, No. 2, April-June 2007 Thai Journal of Anesthesiology 101