Impact of sedation and anesthesia on ECG abnormalities in aged patients undergoing selected gastroscopy: a multicenter, prospective, cohort study

Abstract Background This study aimed to examine the association between different sedation strategies and the risk of electrocardiographic (ECG) abnormalities in older patients undergoing gastroscopy. Methods This pragmatic, prospective cohort study was conducted from October 2018 to December 2019 across 20 centers in 14 provinces in China. Patients aged 70 to 90 years who were scheduled for elective gastroscopy were prospectively enrolled and categorized into three groups according to the sedation strategy implemented in routine clinical practice: the common gastroscopy group (Group C), the moderate sedation group (Group S, receiving sufentanil and midazolam), and the anesthesia group (Group A, receiving sufentanil combined with propofol and etomidate). The choice of sedation strategy was determined by the attending anesthesiologist and endoscopist based on patient condition, procedural requirements, and patient preference. The primary outcome was the incidence of ECG abnormalities, including abnormal rhythm and ST-segment changes. Results A total of 2061 participants were enrolled, comprising the common gastroscopy group (Group C, n = 666), sedation group (Group S, n = 694), and anesthesia group (Group A, n = 701). The prevalence of ECG abnormalities after entering the operating room was 18.1% (373/2061) among the older patients in this study, with abnormal rhythm occurring most frequently (50.6%). Group C exhibited the highest proportion of patients with abnormal rhythm (94.3%: 164/174, P < 0.001). No differences in ischemic changes in ECG were observed across the groups. After adjusting for confounding factors, a higher baseline heart rate (OR: 1.018, 95% CI: 1.000–1.027, P < 0.001), lower ASA grade (OR: 0.537, 95% CI: 0.413–0.699, P < 0.001), and absence of sedation or anesthesia (OR: 2.064, 95% CI: 1.558–2.735, P < 0.001) were identified as independent predictors of ECG abnormalities in elderly patients. Conclusion Sedation or anesthesia was associated with a lower observed incidence of ECG abnormalities and did not increase the incidence of short-term postoperative complications within 1–3 days. Trial registration Chinese Clinical Trial Registry, ChiCTR1800019093 (25/10/2018).