Nurse-Administered Propofol Continuous Infusion Sedation for Gastrointestinal Endoscopy in Patients Who Are Difficult to Sedate

Lee, Hyun Seok; Nagra, Navroop; Selva, Danielle La; Kozarek, Richard A.; Ross, Andrew; Weigel, Wade; Beecher, Ryan; Chiorean, Michael; Glück, Michael; Boden, Elisa K.; Venu, Nanda; Krishnamoorthi, Rajesh; Larsen, Michael; Lin, Otto S.

doi:10.1016/j.cgh.2020.09.018

Cited by 14 publications

(10 citation statements)

References 25 publications

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“…58 Among patients undergoing endoscopy, those who reported daily cannabis use required more fentanyl for procedural sedation than patients who did not use cannabis, but no significant group differences in postprocedure recovery time or frequency of cardiopulmonary events were reported. 287 Multiple observational studies reported a positive association between preoperative cannabis use and postoperative pain and opioid use. A retrospective cohort study of outcomes after total knee arthroplasty, which excluded patients with a history of opioid use, found no difference in postoperative inpatient opioid administration between cannabis users and non-users.…”

Section: Original Researchmentioning

confidence: 99%

ASRA Pain Medicine consensus guidelines on the management of the perioperative patient on cannabis and cannabinoids

Shah

Schwenk

Sondekoppam

et al. 2023

Reg Anesth Pain Med

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BackgroundThe past two decades have seen an increase in cannabis use due to both regulatory changes and an interest in potential therapeutic effects of the substance, yet many aspects of the substance and their health implications remain controversial or unclear.MethodsIn November 2020, the American Society of Regional Anesthesia and Pain Medicine charged the Cannabis Working Group to develop guidelines for the perioperative use of cannabis. The Perioperative Use of Cannabis and Cannabinoids Guidelines Committee was charged with drafting responses to the nine key questions using a modified Delphi method with the overall goal of producing a document focused on the safe management of surgical patients using cannabinoids. A consensus recommendation required ≥75% agreement.ResultsNine questions were selected, with 100% consensus achieved on third-round voting. Topics addressed included perioperative screening, postponement of elective surgery, concomitant use of opioid and cannabis perioperatively, implications for parturients, adjustment in anesthetic and analgesics intraoperatively, postoperative monitoring, cannabis use disorder, and postoperative concerns. Surgical patients using cannabinoids are at potential increased risk for negative perioperative outcomes.ConclusionsSpecific clinical recommendations for perioperative management of cannabis and cannabinoids were successfully created.

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Section: Original Researchmentioning

confidence: 99%

ASRA Pain Medicine consensus guidelines on the management of the perioperative patient on cannabis and cannabinoids

Shah

Schwenk

Sondekoppam

et al. 2023

Reg Anesth Pain Med

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“…All studies were retrospective. Four of the studies compared frequent cannabis use with endoscopic outcomes [ 17 – 20 ], and one evaluated recent cocaine ingestion [ 21 ]. No studies assessed endoscopic outcomes in heroin, methamphetamine, or polysubstance users.…”

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…Cannabis use has been associated with significantly elevated induction doses of propofol in patients undergoing general anesthesia, although the required dose widely varies by study [ 17 , 22 , 23 ]. This finding was also demonstrated in three of four studies evaluating cannabis use and outcomes during endoscopy [ 17 , 18 , 20 ]. In the study by Imasogie, 2021, cannabis users required on average 0.33 mg/kg/min of propofol compared to 0.18 mg/kg/min for non-users, with 61% of variability directly attributable to cannabis use.…”

Section: Discussionmentioning

confidence: 99%

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Illicit Drug Use and Endoscopy: When Do We Say No?

et al. 2022

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Background Illicit drug use (IDU) is often encountered in patients undergoing elective ambulatory surgical procedures such as endoscopy. Given the variety of systemic effects of these drugs, sedation and anesthetics are believed to increase the risk of cardiopulmonary complications during procedures. Procedural cancelations are common, regardless of the drug type, recency of use, and total dosage consumed. There is a lack of institutional and society recommendations regarding the optimal approach to performing outpatient endoscopy on patients with IDU. Aim To review the literature for current recommendations regarding the optimal management of outpatient elective endoscopic procedures in patients with IDU. Secondary aim is to provide guidance for clinicians who encounter IDU in endoscopic practice. Methods Systematic review of PubMed, CINAHL, Embase, and Google Scholar for articles presenting data on outcomes of elective procedures in patients using illicit drugs. Results There are no clinically relevant differences in periprocedural complications or mortality in cannabis users compared to non-users. Endoscopy in patients with remote cocaine use was also found to have similar outcomes to recent use. Conclusions Canceling endoscopic procedures in patients with recent IDU without consideration of the type of drug, dosage, and chronicity may lead to unnecessary delays in care and increased patient morbidity. Healthcare systems would benefit from additional guidelines for evaluating the patient with recent illicit drug use for acute intoxication and consider proceeding with procedures in the non-toxic population.

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“…Other interesting patient factors that have been considered include marijuana use, which was found to be associated with higher sedation demands by Twardowski et al in 2019 [12]. Recently, Lee et al analyzed nurse-administered propofol sedation in gastrointestinal procedures for difficult-to-sedate patients, or those with history of alcohol or opioid abuse, marijuana use, and post traumatic stress disorder (PTSD) [13]. They found marijuana users required higher sedation for both upper endoscopies and colonoscopies, patients with PTSD required higher fentanyl for colonoscopies, and those with history of alcohol abuse needed higher dosages of fentanyl on upper endoscopies.…”

Section: Discussionmentioning

confidence: 99%

The Role of Clinical Characteristics in Stratifying Sedation Risk: A Cohort Study

Rebello

Jamot

et al. 2021

Gastroenterol Res

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Nurse-Administered Propofol Continuous Infusion Sedation for Gastrointestinal Endoscopy in Patients Who Are Difficult to Sedate

Cited by 14 publications

References 25 publications

ASRA Pain Medicine consensus guidelines on the management of the perioperative patient on cannabis and cannabinoids

ASRA Pain Medicine consensus guidelines on the management of the perioperative patient on cannabis and cannabinoids

Illicit Drug Use and Endoscopy: When Do We Say No?

The Role of Clinical Characteristics in Stratifying Sedation Risk: A Cohort Study

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