OPERATIVE EVENTS

Hypoxaemia, the most frequently reported critical event (Table 33), occurred in 3% (21/660) of cases where information was received. However, it is thought that critical events were under-reported as the review of casenotes by advisors revealed several instances of hypoxaemia and perforated viscus which were not acknowledged in the associated questionnaires.

Sedation and monitoring (back to top)

For further comments on sedation and monitoring during GI endoscopy please refer to the earlier chapter entitled ‘Sedation and Monitoring’.

Oxygen should be given to all patients undergoing a PEG procedure, yet at least 6% (41/647) of patients did not receive it (Table 34).

Table 35 includes 27 patients who had a GA or were in ICU receiving IPPV. Where local analgesia was used, 6% (42/679) had the procedure done under topical local anaesthesia
to the oropharynx alone and 30% (203/679) had topical anaesthesia to the oropharynx combined with some form of sedation.

NCEPOD advisors repeatedly expressed concerns that the use of sedation and local anaesthetic spray to the oropharynx may be implicated in pulmonary aspiration and postoperative respiratory complications. This concern was expressed particularly with regard to patients with dysphagia and a history of aspiration, in whom the supine position of the patient during the PEG procedure might facilitate further contamination to the respiratory tree.

The use of flumazenil and naloxone reversal during PEG procedure is presented in Table
36. The high number of questionnaires not answered may reflect missing data but it is more likely that the patient did not need their sedation reversed. The questionnaire should have made this question clearer.

Reversal of sedation was required in 9% (68/719) of patients. This might reflect that some endoscopists have little awareness of the sensitivity that those with neurological disease have to sedative drugs. Best practice guidelines on sedation for PEG procedure may be helpful.