Inventory of the Practice of Sedation Procedural Analgesia in Digestive Endoscopy: Case of Hospitals in the City of Kinshasa

Abstract

<i>Objective</i>: This study was conducted to take stock of the practice of procedural analgesia sedation in digestive endoscopy in Kinshasa hospitals. <i>Methods</i>: This is a cross-sectional study from 06/01/2021 to 06/30/2022 in three Kinshasa hospitals in patients who received sedation analgesia for digestive endoscopy. Socio demographic, preoperative, postoperative variables and complications were sought, analyzed with SPSS 23.0 for <0.05. <i>Results</i>: Four hundred and seven patients were selected; the mean age was 48.069 years (range 2 to 90). The M/F sex ratio was 1.04. The pre-anaesthetic consultation was done the same day in 41.5%, the comorbidities were: arterial hypertension (27%), obesity (4.9%), diabetes (4.2%) and heart disease (3.2%). Pre-anesthetic examinations were prescribed in 70.3%, pre-anesthetic fasting was respected in 95.8%. Mallampati's grade was I (69.8%), II (23.1%) and III (7.1%). ASA classes I and II accounted for 89.7%. Pre oxygenation was done in 96.6% of patients. The products used were: propofol (98.8% for an average dose of 228.11 mg), midazolam (5.4% average dose of 1.53mg), ketamine (4.2% the average dose of 9.6mg), fentanyl (32.7% mean dose of 38.66μg), sufentanil (9.2% mean dose of 3.86μg) and haloperidol (7.6%). The endoscopy performed was high (56.8%), low (25.3%) and combined (16.5%). The procedure performed was: exploration/biopsy (53.8%), exploration (23.3%), removal of the foreign body (3.4%) and haemostasis (3.2%). Complications were present in 47.7% (desaturation, cough, arterial hypotension, bradycardia, tachycardia, arterial hypertension, spasm and apnea). The high total doses of the products (fentanyl, midazolam and ketamine) were associated with complications but in multivariate analysis, persisted: the grade of Mallampati III, the ASA class IV, the duration of the procedures greater than or equal to ten minutes, endoscopy combined and the junior anesthesiologist. <i>Conclusion</i>: Procedural analgesia sedation in Kinshasa is increasingly practiced in gastrointestinal endoscopies. It is provided by anesthesiologists who use the same products cited in the literature but with a relatively high rate of complications.