Nurse-administered propofol sedation without anesthesia specialists in 9152 endoscopic cases in an ambulatory surgery center

Abstract

Narcotics and benzodiazepines are commonly used for sedation for endoscopy in the United States. Propofol has certain advantages over narcotics and benzodiazepines, but its use is often controlled by anesthesia specialists. This report describes our experience with dosage, safety, patient satisfaction, and discharge time with nurse-administered propofol sedation in 9152 endoscopic cases. The study was performed in a private practice ambulatory surgery center in Medford, Oregon. With the assistance of an anesthesiologist, we developed a protocol for administration of propofol in routine endoscopic cases, in which propofol was given by registered nurses under the supervision of endoscopists or gastroenterologists. We then applied the protocol with 9152 patients. There were seven cases of respiratory compromise (three prolonged apnea, three laryngospasm, one aspiration requiring hospitalization), all associated with upper endoscopy. Five patients required mask ventilation, but none required endotracheal intubation. There were seven colonic perforations (<1 per 1000 colonoscopies), of which three may have involved forceful sigmoid disruption. Of patients who had previously received narcotic or benzodiazepine sedation, 84% preferred propofol. Gastroenterologists strongly preferred propofol. The mean time from completion of procedures to discharge in a sample of 100 patients was 18 min.Nurse-administered propofol sedation in an ambulatory surgery center was safe and resulted in high levels of patient satisfaction and rapid postprocedure recovery and discharge.

Sedation for gastrointestinal endoscopy with the application of target-controlled infusion

“…In addition, undesirable cardiovascular or respiratory side effects may occur when propofol is used with opioids. Although previous studies have revealed that propofol is safe when given by registered nurses without any involvement by anesthesia specialists, several patients may require a brief period of mask ventilation for the management of prolonged apnea (10,(18)(19)(20). This side effect occurs because of the narrow therapeutic range and the lack of an antidote in cases of over-sedation and subsequent apnea.…”

“…A few studies have assessed the safety of physician-and nurse-administered propofol sedation (9,10). However, many practitioners never receive formal instruction in sedation methods.…”

Perioperative Implementation of Continuous Positive Airway Pressure: A Review of the Considerations

“…There are many reports of the safe administration of these sedations, even with drugs not specifically approved for this indication, such as propofol [40,41]. However, the majority of the morbidity and mortality related to sedation practice is the result of respiratory compromise.…”

Estudo comparativo de eficácia e segurança entre propofol e midazolam durante sedação para colonoscopia

“…A droga ideal para sedação durante os procedimentos endoscópicos deve possuir as seguintes caracterís-ticas: efeito imediato, sedação somente enquanto durar o procedimento, recuperação da consciência rapidamente, sem período residual de desordens mentais ou psicomotoras, e baixa incidência de efeitos colaterais. O uso rotineiro de uma droga de ação curta tem sido recomendado por muitos autores, sendo um meio para aumentar o conforto durante os procedimentos endoscópicos, resultando em procedimento de menor duração com um tempo de recuperação da consciência mais rápido 2,[4][5][6][7][8][9][10] . O propofol (2,6-diisopropylphenol) é agente aprovado pelo Food and Drug Administration (FDA) dos USA, de ação extremamente curta no sistema nervoso central, classificado como droga que promove atividade do ácido gama aminobutírico (GABA) no cérebro, com propriedades sedativas e hipnóticas.…”