Patient- versus medical practitioner-controlled sedation with propofol: systematic review and meta-analysis

Kreienbuehl, Lukas; Aldenkortt, Marc; Tramèr, Martin R.

doi:10.1097/00003643-201406001-00076

Cited by 3 publications

(6 citation statements)

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“…A consistent finding in clinical studies of patient-controlled propofol sedation is that the time from commencement of the sedation regime to obtaining adequate depth of sedation for a procedure to begin is longer than with traditional physician-delivered sedation techniques. 2,3 This finding seems fairly consistent regardless of whether the patient system is patient-controlled (patients delivering fixed bolus doses of propofol) or patientmaintained (patients incrementing a target-controlled infusion of propofol). 4,5 It is clearly of fundamental importance to patient experience that a person is adequately sedated before a procedure begins (although they can then change this sedative depth using patient-led systems).…”

Section: Counting the Costs Of Patient-led Propofol Sedationmentioning

confidence: 59%

Counting the costs of patient‐led propofol sedation

Hewson

2020

Acta Anaesthesiol Scand

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Section: Counting the Costs Of Patient-led Propofol Sedationmentioning

confidence: 59%

Counting the costs of patient‐led propofol sedation

Hewson

2020

Acta Anaesthesiol Scand

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“…Studies addressing the use of PCS as method of sedation have found that the risk for cardiorespiratory adverse events, such as hypotension and airway obstruction, and oversedation increases when propofol administration is carried out by professionals instead of patients themselves using PCS. 4 Procedure feasibility is a very important issue both from the patients' and endoscopists' perspective, but also an economic perspective. Feasibility is dependent on several factors, including the ease of introducing the endoscope, cough and patient cooperation/movement, which are common for many endoscopic procedures.…”

Section: Ta B L E 3 (Continued)mentioning

confidence: 99%

“…18 Another important factor, patient satisfaction is high using propofol. 4 Concerns have been raised whether PCS, compared with conventional midazolam sedation performed by an endoscopic team, is safe when administered by non-anaesthesiologists. Although controversial, it has been shown that propofol can be administered safely by trained non-anaesthesiologists 19 or by patients using the PCS device.…”

Section: Ta B L E 3 (Continued)mentioning

confidence: 99%

“…Although controversial, it has been shown that propofol can be administered safely by trained non-anaesthesiologists 19 or by patients using the PCS device. 4,12 Based on our experiences, an endoscopic clinic can successfully make the transition from midazolam sedation to PCS, with or without bedside anaesthesia personnel. This is possible by attaining the required equipment, knowledge and experience through thorough educational and practical training and conducting regular safety follow-ups led by skilled anaesthesia personnel.…”

Section: Ta B L E 3 (Continued)mentioning

confidence: 99%

“…1,2 PCS compared with traditional sedation is considered safe in terms of low risk for cardiorespiratory adverse events, 3 oversedation and rescue interventions. 4 Propofol results in faster recovery, [5][6][7] higher patient satisfaction, 8 increased tolerance 8,9 than midazolam without affecting procedure feasibility. [5][6][7] Both the amount of endoscopic procedures and the use of propofol for sedation have increased during the last decade.…”

Section: Introductionmentioning

confidence: 99%

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Patient‐controlled sedation with propofol for endoscopic procedures—A cost analysis

Grossmann

Nilsson

Sjöberg

et al. 2019

Acta Anaesthesiol Scand

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Background: Patient-controlled sedation (PCS) with propofol accompanied by a bedside nurse anaesthetist is an alternative sedation method for endoscopic procedures compared with midazolam administered by a nurse or endoscopist. Increasing costs in health care demands an economic perspective when introducing alternative methods. We applied a hospital perspective on a cost analysis comparing different methods of sedation and the resource use that were expected to affect cost differences related to the sedation.Methods: Based on two randomised previous studies, the direct costs were determined for different sedation methods during two advanced endoscopic procedures: endoscopic retrograde cholangiopancreatography (ERCP) and flexible bronchoscopy including endobronchial ultrasound. ERCP comparisons were made between midazolam sedation by the endoscopic team, PCS with a bedside nurse anaesthetist and propofol sedation administered by a nurse anaesthetist. Bronchoscopy comparisons were made between midazolam sedation by the endoscopic team and PCS with a bedside nurse anaesthetist, categorised by premedication morphine-scopolamine or glycopyrronium.Results: Propofol PCS with a bedside nurse anaesthetist resulted in lower costs per patient for sedation for both ERCP (233 USD) and bronchoscopy (premedication morphine-scopolamine 267 USD, premedication glycopyrronium 269 USD) compared with midazolam (ERCP 425 USD, bronchoscopy 337 USD). Aborted procedures that needed to be repeated and prolonged hospital stays significantly increased the cost for the midazolam groups. Conclusion:Propofol PCS with a bedside nurse anaesthetist reduces the direct sedation costs for ERCP and bronchoscopy procedures compared with midazolam sedation.

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Sedation-analgesia techniques for nonoperating room anesthesia: an update

Khorsand¹,

Karamchandani²,

Joshi³

2022

Current Opinion in Anaesthesiology

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Purpose of reviewThere has been a substantial increase in nonoperating room anesthesia procedures over the years along with an increase in the complexity and severity of cases. These procedures pose unique challenges for anesthesia providers requiring meticulous planning and attention to detail. Advancements in the delivery of sedation and analgesia in this setting will help anesthesia providers navigate these challenges and improve patient safety and outcomes. Recent findingsThere has been a renewed interest in the development of newer sedative and analgesic drugs and delivery systems that can safely provide anesthesia care in challenging situations and circumstances. SummaryDelivery of anesthesia care in nonoperating room locations is associated with significant challenges. The advent of sedative and analgesic drugs that can be safely used in situations where monitoring capabilities are limited in conjunction with delivery systems, that can incorporate unique patient characteristics and ensure the safe delivery of these drugs, has the potential to improve patient safety and outcomes. Further research is needed in these areas to develop newer drugs and delivery systems.

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Patient- versus medical practitioner-controlled sedation with propofol: systematic review and meta-analysis

Cited by 3 publications

References 0 publications

Counting the costs of patient‐led propofol sedation

Counting the costs of patient‐led propofol sedation

Patient‐controlled sedation with propofol for endoscopic procedures—A cost analysis

Sedation-analgesia techniques for nonoperating room anesthesia: an update

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