High efficacy with deep nurse-administered propofol sedation for advanced gastroenterologic endoscopic procedures

Abstract

Background and study aims: Whereas data on moderate nurse-administered propofol sedation (NAPS) efficacy and safety for standard endoscopy is abundant, few reports on the use of deep sedation by endoscopy nurses during advanced endoscopy, such as Endoscopic Retrograde Cholangiopancreatography (ERCP) and Endoscopic Ultrasound (EUS) are available and potential benefits or hazards remain unclear. The aims of this study were to investigate the efficacy of intermittent deep sedation with propofol for a large cohort of advanced endoscopies and to provide data on the safety. Patients and methods: All available data from patients sedated with intermittent deep NAPS for ERCP, EUS or double balloon enteroscopy (DBE, since the method was implemented in May 2007 through December 2012 were included for evaluation in a retrospective case-control design. Results: Data from 1899 patients undergoing 1899 procedures were included for evaluation. All but one procedure were completed with intermittent deep NAPS. The mean propofol dose was 397 mg (SD: 232.4) and the infusion rate was 23.9 mg/kg. The frequency of hypoxia was 4.3 % and 20 patients needed assisted ventilation (1.1 %). Anesthesiologic support was requested eight times (0.4 %). One patient was intubated due to suspected aspiration. Conclusions: Intermittent deep NAPS for advanced endoscopies in selected patients provided an almost 100 % success rate. However, the rate of hypoxia, hypotension and respiratory support was high compared with previously published data, but the method was still assessed as safe.

Efficacy and Safety of Non-Anesthesiologist Administration of Propofol Sedation in Endoscopic Ultrasound: A Propensity Score Analysis

“…Our results confirm that the incidence of major sedation-related complications is very low (0.3%) both in NAAP and anesthesia specialist-administered propofol sedation, a finding in keeping with the current literature [ 3 , 24 ]. Of note, no fatal event was registered in our series.…”

“…Propofol was administered as intermittent bolus monotherapy, using the same guidelines as for standard endoscopies [ 24 ]. Sufficient sedation for easy introduction of the endoscope was achieved with an initial bolus of propofol (0.5–1 mg/kg) administered intravenously, followed by a repeated bolus (10–20 mg), according to the patient’s condition.…”

Nurse Administered Propofol Sedation (NAPS) versus On-call Anesthesiologist Administered Propofol Sedation (OAPS) in Elective Colonoscopy

“…29 No 4: 579-585 by anesthesiologists or certified nurse anesthetists [9]. The concern is that inadequate experience in recognizing and managing cardiopulmonary adverse events associated with propofol used, especially hypoventilation, obstructed airway and cardio-circulatory depression can potentially compromise the patient's safety [10,11]. As a result, the practice of NAPS is not widely accepted in some countries such as the United States and certain countries in Asia [9,[12][13][14].…”

Are Gastrointestinal Endoscopic Procedures Performed by Anesthesiologists Safer Than When Sedation is Given by the Endoscopist?

“…There have been multiple previous publications comparing an expanded class of AEs when using anesthesia, primarily with propofol assistance for endoscopic procedures compared with endoscopist-given sedation using midazolam and fentanyl. [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] In one, Cooper et al 6 reviewed a random sample of 5% of all Medicare patients undergoing colonoscopy without polypectomy in 1 of the regions served by the Surveillance, Epidemiology, and End Results registry. These authors reviewed 165,527 procedures, 21.2% of which were done with anesthesia services.…”