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Risk Factors and Outcomes of Reversal Agent Use in Moderate Sedation During Endoscopy and Colonoscopy

Hung, Adelina MD; Marshall, John PharmD; Barnett, Sheila MD; Falchuk, Zalman M. MD; Sawhney, Mandeep MD; Leffler, Daniel A. MD, MS

Journal of Clinical Gastroenterology: March 2016 - Volume 50 - Issue 3 - p e25–e29
doi: 10.1097/MCG.0000000000000291
ONLINE ARTICLES: Original Articles

Background: Moderate sedation has been standard for noninvasive gastrointestinal procedures for decades yet there are limited data on reversal agent use and outcomes associated with need for reversal of sedation.

Aim: To determine prevalence and clinical significance of reversal agent use during endoscopies and colonoscopies.

Methods: Individuals with adverse events requiring naloxone and/or flumazenil during endoscopy or colonoscopy from 2008 to 2013 were identified. A control group was obtained by random selection of patients matched by procedure type and date. Prevalence of reversal agent use and statistical comparison of patient demographics and risk factors against controls were determined.

Results: Prevalence of reversal agent use was 0.03% [95% confidence interval (CI), 0.02-0.04]. Events triggering reversal use were oxygen desaturation (64.4%), respiration changes (24.4%), hypotension (8.9%), and bradycardia (6.7%). Two patients required escalation of care and the majority of patients were stabilized and discharged home. Compared with the control group, the reversal group was older (61±1.8 vs. 55±1.6, P=0.01), mostly female (82% vs. 50%, P<0.01), and had lower body mass index (24±0.8 vs. 27±0.7, P=0.03) but received similar dosages of sedation. When adjusted for age, race, sex, and body mass index, the odds of reversal agent patients having a higher ASA score than controls was 4.7 (95% CI, 1.7-13.1), and the odds of having a higher Mallampati score than controls was 5.0 (95% CI, 2.1-11.7) with P<0.01.

Conclusions: Prevalence of reversal agent use during moderate sedation is low and outcomes are generally good. Several clinically relevant risk factors for reversal agent use were found suggesting that certain groups may benefit from closer monitoring.

Departments of *Gastroenterology


Division of Pharmacy, Beth Israel Deaconess Medical Center (BIDMC), Boston, MA

The authors declare that they have nothing to disclose.

Reprints: Adelina Hung, MD, Beth Israel Deaconess Medical Center, 330 Brookline Ave., Boston, MA 02215 (e-mail:

Received October 23, 2014

Accepted December 9, 2014

Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.