Nurse-administered propofol sedation for endoscopy: a risk analysis during an implementation phase

Abstract

These results were obtained after development of a structured training program both for endoscopists and nurses using propofol for sedation, and can be used as basis for further comparison. NAPS for endoscopic procedures is safe when performed by personnel properly trained in airway handling and sedation with propofol, and has considerable advantages compared with conventional sedation for endoscopy.

Propofol administration by endoscopists versus anesthesiologists in gastrointestinal endoscopy: a systematic review and meta-analysis of patient safety outcomes

“…Several sedation training programs for endoscopists and nurses have been developed in an attempt to increase comfort achieving deeper levels of sedation safely. 8,29 However, endoscopists may also be hesitant to undertake the training and changes in practice needed to adopt NAAP. 4 Furthermore, litigation risk continues to pose a major barrier.…”

Propofol-Based Sedation in Gastrointestinal Endoscopy: Getting Safer and Safer

“…One result of this guideline conference was the structured 3-day training course ‘Sedation and Emergency Management in Endoscopy for Endoscopy Nurses and Assisting Personnel' for nurses to be able to perform the sedation supervised by the endoscopist. Several trials confirm that adequately trained nurses supervised by endoscopists are able to safely administer propofol sedation for endoscopy procedures [7,8,9]. In a recently published trial, we were able to demonstrate that these training courses for nurses improved structures in gastrointestinal endoscopy with respect to patient safety [10].…”

Patient safety under deep sedation for digestive endoscopic procedures

“…Slagelse et al (32), in a study of 2,527 patients, reported that 4.7% of patients had hypoxemia, 2.4% needed aspiration for secretions or regurgitation, 1.3% had blood pressure changes above 30%, and 0.9% required ventilation support. Jemsen et al (33), in a study with 1,764 patients, found hypoxemia in 4.4%, with significant differences between gastroscopy (5.7%) and colonoscopy (2.9%); 19 patients (1.1%) required respiratory support. Redondo-Cerezo et al (34), in a series of 446 patients sedated with propofol, reported a 9% complication rate with 8% respiratory complications.…”

“…The underestimation or relativization of complications from propofol sedation as administered by non-anesthesiologists in some papers remains controversial (26)(27)(28)(29)(30)(31)(32)(33)(34). As an example, we mention here some of these reports where authors usually conclude that propofol sedation by non-anesthesiologists is a safe technique following the identification of multiple incidences, some of them potentially serious.…”