Documento de consenso de la Asociación Española de Gastroenteología sobre sedoanalgesia en la endoscopia digestiva

Simón, Miguel Ángel; Bordas, J.M.; Campo, Rafel; González-Húix, Ferrán; Igea, Francisco; Monés, J

doi:10.1157/13085143

Cited by 24 publications

(13 citation statements)

References 91 publications

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“…Furthermore, the presence of an anesthetist to administer deep sedation with propofol in the Digestive Endoscopy Unit is controversial (34). Several national and international guidelines (4,31) recommend the presence of a cardio-respiratory reanimation trained nurse to monitor vital signs and to administer propofol. Due to human resources problems, we rarely have at our disposal a second nurse exclusively in charge of sedation.…”

Section: Discussionmentioning

confidence: 99%

Safety of continuous propofol sedation for endoscopic procedures in elderly patients

Martínez

Aparicio

Ruiz

et al. 2011

Rev. esp. enferm. dig.

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Objective: to evaluate safety of continuous propofol sedation in elderly patients who undergo endoscopic procedures and investigate risk factors to develop complications in the geriatric population.Material and methods: patients who received endoscopistdirected propofol sedation were classified into two groups according to age. Group I: > 80 years; Group II: < 80 years. Propofol was administered by continuous intravenous infusion to achieve deep sedation. Arterial oxygen saturation, heart rate, blood pressure, and electrocardiographic records were monitored during the procedure. Therapy and complications secondary to sedation were recorded.Results: one thousand two-hundred and ninety-five endoscopic procedures (gastroscopies, colonoscopies and endoscopic ultrasonographies) were included. The dose of propofol was lower and therapy was more frequently performed in Group I. There were no differences between sedation-related complications in both groups (Group I: 15.4%; Group II: 14%; p, NS). Patients in Group I showed greater tendency to develop severe oxygen desaturation in the colonoscopy and endoscopic ultrasonography procedures. In the univariate analysis, a higher dose of propofol was associated with the appearance of complications (157.4 ± 84.4 vs. 121.3 ± 89.6 mg) in elderly patients but it was not associated with severe oxygen desaturation.Conclusions: continuous propofol sedation during endoscopic procedures in elderly patients > 80 years is as safe as in younger patients.

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Section: Discussionmentioning

confidence: 99%

Safety of continuous propofol sedation for endoscopic procedures in elderly patients

Martínez

Aparicio

Ruiz

et al. 2011

Rev. esp. enferm. dig.

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“…[1234567] These complications are more frequent when patients are deeply sedated, undergo complex or prolonged explorations, or undergo therapeutic procedures. [46] Respiratory complications are very significant in high-risk patients.…”

Section: Introductionmentioning

confidence: 99%

Utility of noninvasive ventilation in high-risk patients during endoscopic retrograde cholangiopancreatography

et al. 2014

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Background:There is little evidence on noninvasive ventilation (NIV) preventing respiratory complications in high-risk patients undergoing endoscopy procedures.Objectives:The objective of this study is to demonstrate that the application of NIV through a nasal interface can prevent the appearance of ventilatory alterations during endoscopic retrograde cholangiopancreatography (ERCP) in patients with risk factors associated with the development of hypoventilation.Patients and Methods:A non-randomized interventional study was performed on 37 consecutive high-risk patients undergoing ERCP. During the procedure, 21 patients received oxygen by nasal cannula (3 L/minute) and sixteen received NIV through a nasal mask. Arterial blood gas analyses were conducted before and immediately after the ERCP. An Acute Physiology and Chronic Health Evaluation (APACHE) score pre-ERCP was recorded. The complications during the procedure were recorded.Results:The groups with and without NIV were comparable. A post-ERCP pH of <7.35 was found in eight patients, who did not receive ventilatory support (38.1%) compared to zero patients in the NIV group (P = 0.006). A post-ERCP pCO2 >45 mmHg was found in one case (6.3%) in the NIV-group and in nine cases in the nasal cannula group (42.9%; P = 0.01). The median pCO2 post-ERCP was lower (36.5 ± 6.2 vs. 44.5 ± 6.8 mmHg) (P = 0.001) and median pH post-ERCP was higher (7.41 ± 0.4 vs. 7.34 ± 0.5) (P = 0.001) in patients treated with NIV. In the multivariate analysis, after adjusting for gender, the APACHE score, pH and pCO2 pre-ERCP, age, propofol doses, and procedure duration, the following differences were maintained (pCO2 difference = 5.54, 95% Confidence Interval (CI) =2.3 – 8.7, pH difference = 0.047, and 95% CI = 0.013 – 0.081). Among the 37 procedures, four complications occurred: One in the NIV group and three in the nasal cannula group. None of them was related to NIV.Conclusions:Our preliminary results demonstrate that in high-risk patients undergoing ERCP, hypercapnia and respiratory acidosis are frequent. NIV prevents the appearance of these complications.

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“…This has generated much controversy over who should be responsible for the sedation and monitoring of patients and whether non anesthesiologists are prepared or not to use propofol, mainly due to the narrow therapeutic index of this drug. The debate has been partially solved with the emergence of several clinical management guidelines published by various scientific societies, which set conditions to be fulfilled by staff dedicated to both conscious and deep sedation, and situations in which it must be carried out by anesthesiologists (4)(5)(6)(7)(8)(9)(10)(11)(12). However, despite the great number of published studies about sedation controlled by physicians or certified nurses, in gastrointestinal endoscopy (13)(14)(15), there are very few of them that value its use in advanced endoscopic procedures (2,(16)(17)(18)(19)(20).…”

Section: Introductionmentioning

confidence: 99%

“…Ello ha generado una gran polémica en torno a quién debería encargarse de la sedación y monitorización de los pacientes y si el personal sanitario no anestesiólogo está o no capacitado para emplear propofol, debido principalmente al estrecho margen terapéutico de este fármaco. El debate ha sido zanjado parcialmente tras la aparición de varias guías de manejo clínico publicadas por diferentes sociedades científicas, que establecen las condiciones que debe cumplir el personal dedicado a la sedación tanto superficial como profunda y las situaciones en las que la misma debe ser llevada a cabo por anestesiólogos (4)(5)(6)(7)(8)(9)(10)(11)(12). No obstante, a pesar de la gran cantidad de trabajos publicados sobre sedación en endoscopia digestiva controlada por médicos no anestesistas o enfermeras entrenadas (13)(14)(15), apenas existen artículos que se refieran a su empleo durante procedimientos de endoscopia avanzada (2,(16)(17)(18)(19)(20).…”

Section: Introductionunclassified

Sedation with propofol controlled by endoscopists during percutaneous endoscopic gastrostomy

García-Suárez

López-Rosés

Olivencia

et al. 2010

Rev. esp. enferm. dig.

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Background: propofol is a hypnotic used with increasing frequency for sedation during endoscopic procedures. Most of the reports published related with its employment by non-anaesthesiologists, refers to basic endoscopy, with little reference to its use in advanced endoscopy.Objective: to evaluate the efficacy and safety of propofol sedation administered by endoscopists, while performing percutaneous endoscopic gastrostomy, an advanced technique that is usually performed in high anesthetic level risk patients.Material and methods: prospective study of a series of endoscopic gastrostomy performed consecutively in our department; the sedation was carried out exclusively with propofol. The staff in the room consisted of two medical gastroenterologists, a nurse and a nursing assistant. Propofol was administered by bolus doses adjusted to patient weight. Arterial oxygen saturation, heart rate and blood pressure were monitored; respiratory activity was monitored visually by observing respiratory excursions of the patient.Results: we included 47 patients, with an average age of 82 years. 87% were ASA III and the rest, ASA IV. The mean dose of propofol was 51 mgr. Complications were recorded: 8 cases of desaturation and two of hypotension, all of them minor and quickly reversible. All procedures were carried out successfully, at a median time of 8 minutes.Conclusion: the propofol sedation carried out by non-anaesthesiologist trained staff, seems to appear as a safe and effective procedure while performing percutaneous endoscopic gastrostomy.

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Documento de consenso de la Asociación Española de Gastroenteología sobre sedoanalgesia en la endoscopia digestiva

Cited by 24 publications

References 91 publications

Safety of continuous propofol sedation for endoscopic procedures in elderly patients

Safety of continuous propofol sedation for endoscopic procedures in elderly patients

Utility of noninvasive ventilation in high-risk patients during endoscopic retrograde cholangiopancreatography

Sedation with propofol controlled by endoscopists during percutaneous endoscopic gastrostomy

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