We would like to compliment Cooper et al1 on their recent study; however, the issues of using propofol during endoscopy go beyond their findings. Propofol, when used for deep sedation in gastrointestinal (GI) endoscopy, can lead to airway obstruction and apnea. Airway-associated complications are responsible for approximately 30% of all perioperative deaths during deep sedation provided in remote locations. With improvements in diagnostic and therapeutic techniques, anesthesia requirements at remote locations have increased. The reported incidence of cardiac arrests during general anesthesia is approximately 5.5 per 10 000 patients.2 Similarly, values for spinal and regional anesthesia are 1.3 to 1.8 and approximately 1.5 per 10 000 patients, respectively.2,3 Inevitably, sedation provided at remote anesthesia locations is also subject to complications, including cardiorespiratory arrests.
Goudra BGB, Singh PM. Cardiac Arrests During Endoscopy With Anesthesia Assistance. JAMA Intern Med. 2013;173(17):1659-1660. doi:10.1001/jamainternmed.2013.8756