Safety of Non-anesthesia Provider-Administered Propofol (NAAP) Sedation in Advanced Gastrointestinal Endoscopic Procedures: Comparative Meta-Analysis of Pooled Results

Goudra, Basavana Gouda; Singh, Preet Mohinder; Gouda, Gowri; Borle, Anuradha; Gouda, Divakara; Dravida, Amulya; Chandrashakhara, Vinay

doi:10.1007/s10620-015-3608-x

Cited by 86 publications

(78 citation statements)

References 43 publications

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“…In addition, since propofol is also used in intensive care patients and with other clinical sedative treatment (9). Propofol has a number of characteristics that make it advantageous as an anesthetic, including taking effect quickly, short metabolic time, easy control of narcosis and slight adverse reactions.…”

Section: Introductionmentioning

confidence: 99%

Propofol promotes apoptosis and suppresses the HOTAIR-mediated mTOR/p70S6K signaling pathway in melanoma cells

et al. 2017

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Abstract.Propofol is an intravenous anesthetic, which is widely used in clinical anesthesia induction and maintenance and is critical in the sedation of patients. However, the functions and mechanisms of propofol on apoptosis of melanoma cells remain unclear. The present study investigated whether propofol promotes cell apoptosis and suppresses the HOX transcript antisense RNA (HOTAIR)-mediated mechanistic target of rapamycin (mTOR) pathway in melanoma cells. B16F10 cells were cultured with different concentrations (0-10 µM) of propofol for 24 or 48 h. Proliferation and apoptosis of B16F10 cells were detected using MTT assay and flow cytometry. The pcDNA 3

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Section: Introductionmentioning

confidence: 99%

Propofol promotes apoptosis and suppresses the HOTAIR-mediated mTOR/p70S6K signaling pathway in melanoma cells

et al. 2017

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“…14,15 However, the push toward containment of health care costs has brought into question the sustainability of anesthesiologist-administered propofol (AAP) in healthy patients at low risk undergoing routine endoscopic procedures. 12,[16][17][18] In fact, non-anesthesiologistadministered propofol (NAAP) has already been endorsed and widely implemented in several European countries. 17,19 In 2008, Singh and colleagues 7 conducted a systematic review on the safety of NAAP but identified only 1 study comparing NAAP to AAP.…”

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confidence: 99%

“…In a 2015 comparative metaanalysis, the authors concluded that NAAP compares favourably with AAP for patients undergoing advanced endoscopic procedures. 18 However, the question remains largely unanswered for routine endoscopic procedures. Thus, the purpose of this systematic review was to evaluate whether patient safety and procedure quality are compromised when nonanesthesiologists (i.e., endoscopists) administer propofol in routine upper or lower gastrointestinal endoscopy.…”

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confidence: 99%

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

Daza

Tan

Fielding

et al. 2018

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Background: With a growing demand for endoscopic services, the role of anesthesiologists in endoscopy units must be reassessed. The aim of this study was to compare patient outcomes in non-anesthesiologist-administered propofol (NAAP) versus anesthesiologist-administered propofol (AAP) during routine endoscopy. Methods:We systematically searched MEDLINE, CINAHL, Embase, Web of Science, CENTRAL and the grey literature for studies comparing NAAP and AAP. Primary outcomes included endoscopy-and sedation-related complications. Secondary outcomes included measures of endoscopy quality and of patient and endoscopist satisfaction. We reported treatment effects using random-effects models. Nonanesthesiologists administered lower propofol dosages than anesthesiologists (mean difference −61.79, 95% CI −114.46 to −9.12; 3443 patients), and their patients more commonly experienced awareness with recall (OR 19.99, 95% CI 7.88 to 50.76; 2090 patients). However, NAAP neither compromised patient willingness to repeat the procedure (OR 0.42, 95% CI 0.10 to 1.83; 2367 patients) nor lengthened total procedure time (mean difference −0.08, 95% CI −3.51 to 3.34; 2367 patients). Results Conclusion:Endoscopists may safely administer propofol without compromising procedural quality in patients classified as ASA I or II undergoing routine endoscopy. The results of this meta-analysis are limited by a lack of available high-quality studies. Further, large-scale studies are needed for definitive conclusions.Contexte : Étant donné que les services endoscopiques sont de plus en plus demandés, le rôle des anesthésiologistes dans les unités d'endoscopie doit être réévalué. Le but de cette étude était de comparer les résultats cliniques chez les patients selon que le propofol était administré par des non-anesthésiologistes (NAAP, pour nonanesthesiologist-administered propofol) ou par des anesthésiologistes (AAP, pour anesthesiologist-administered propofol).Méthodes : Nous avons procédé à une revue systématique des réseaux MEDLINE, CINAHL, Embase, Web of Science et CENTRAL et de la littérature grise pour recenser les études ayant comparé les méthodes NAAP et AAP. Les paramètres principaux incluaient les complications liées à l'endoscopie et à la sédation, et les paramètres secondaires incluaient les mesures de la qualité de l'endoscopie et la satisfaction des patients et des endoscopistes. Nous avons fait état des effets des traitements à l'aide de modèles à effets aléatoires.

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“…Meta-analysis of sedation regimens is usually limited by heterogeneity resulting from varying sedation regimen, the use of additional anesthetics such as morphine derivatives or benzodiazepines, and potential bias in that more complex patients are more likely to be referred to an anesthesiologist [2]. Although this heterogeneity is also present in the study by Goudra et al, its results complement and expand the existing data supporting the general use of AAP-administered sedation in GI endoscopy.…”

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confidence: 84%

“…In this issue of Digestive Diseases and Sciences, Goudra et al [2] conducted a comparative meta-analysis evaluating respiratory complications of AAP-or NAAP-administered sedation during advanced GI endoscopic procedures. The authors provide data with regard to 3018 advanced GI endoscopic procedures carried out using NAAP-administered sedation and 2374 AAP-administered procedures.…”

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confidence: 99%

Anesthesiologist-Administered Gastrointestinal Sedation: Time to Put It to Sleep?

Friedrich

Stremmel

2015

Dig Dis Sci

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Safety of Non-anesthesia Provider-Administered Propofol (NAAP) Sedation in Advanced Gastrointestinal Endoscopic Procedures: Comparative Meta-Analysis of Pooled Results

Abstract: The safety of NAAP sedation compared favorably with AAP sedation in patients undergoing advanced endoscopic procedures. However, it came at the cost of decreased patient and endoscopist satisfaction.

Cited by 86 publications

References 43 publications

Propofol promotes apoptosis and suppresses the HOTAIR-mediated mTOR/p70S6K signaling pathway in melanoma cells

Propofol promotes apoptosis and suppresses the HOTAIR-mediated mTOR/p70S6K signaling pathway in melanoma cells

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

Anesthesiologist-Administered Gastrointestinal Sedation: Time to Put It to Sleep?

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