Safety of Nonanesthetist Sedation with Propofol for Outpatient Colonoscopy and Esophagogastroduodenoscopy

Background: Using gentler endoscopes and improved sedation, great strides have been made in enhancing patients’ comfort and acceptance of endoscopic procedures. Because morbidity and mortality have been associated with benzodiazepines in endoscopic sedation, safer alternatives were sought. Propofol (2,6-diisopropylphenol), a rapid and short-acting anesthetic, initially used in the 1980’s for general anesthesia induction and maintenance, is a promising candidate. Methods: This review article examines experiences and literature references of propofol’s use in endoscopic procedures. Three critical questions are posed: What are the major advantages and potential risks of propofol? When should propofol be used? Who should administer propofol, how should it be administered, and what type of monitoring is required? Results: With considerable inter-patient variability, the propofol dose must be carefully titrated according to the individual patient’s response. Factors influencing dosage include age, ASA class, patient’s height and procedure duration. Propofol’s primary risk is its narrow therapeutic range which necessitates careful patient monitoring. Conclusions: Propofol’s advantages over benzodiazepines and narcotics include a more rapid onset of action, full relief of discomfort and rapid recovery to alertness without residual sedative effects or anterograde amnesia, thereby making this drug a cost-effective and, with proper monitoring, safe choice.

Section: Advantages and Potential Risks Of The Drugmentioning

confidence: 99%

Section: Advantages and Potential Risks Of The Drugmentioning

confidence: 99%

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The Dawning of a New Sedative: Propofol in Gastrointestinal Endoscopy

Heuss

Inauen²

2004

“…Propofol is a good candidate for the sedative agent in diagnostic EGD in that it is superior to benzodiazepines with regard to rapidity of induction of sedation and is associated with faster recovery. However, the possibility of respiratory depression has made many endoscopists reluctant to use propofol routinely [1,2,3,4,5,6,7,8,9,10,11]. …”

Section: Introductionmentioning

confidence: 99%

Safety and Driving Ability following Low-Dose Propofol Sedation

Horiuchi¹,

Nakayama

Katsuyama

et al. 2008

Background and Aim: Automobile driving is prohibited after midazolam sedation because of the slow recovery of psychomotor function. This study prospectively assessed the safety of low-dose propofol sedation (study 1) and compared driving ability following propofol and midazolam sedation (study 2). Methods: Study 1: We prospectively investigated bolus injection of a low-dose of propofol (40–80 mg for <70 years and 30 mg for ≥70 years) for diagnostic esophagogastroduodenoscopy (EGD). Respiratory depression, time to full recovery, and overall patient satisfaction were evaluated and blood concentrations of propofol were measured. Study 2: A subset of subjects undergoing diagnostic EGD were randomized to receive 40 mg of propofol (n = 30), 4 mg of midazolam (n = 30) or no sedation controls (n = 20), and the residual effects of each drug were tested using a driving simulator. The primary outcome measure was driving ability. The second outcome measures were overall patient satisfaction and complications. Results: Study 1: Only 1.1% of 12,031 healthy subjects developed transient oxygen desaturation. Full recovery was present in 97.5% 30 min after the procedure; 99.8% were willing to repeat the same procedure. The blood levels of propofol (40–80 mg) at 60 min were <100 ng/ml. Study 2: Driving ability recovered to the basal level within 60 min of propofol administration but not with 120 min with midazolam. There were no complications; overall patient satisfaction was similar between propofol and midazolam (8.9 vs. 8.5, p = 0.34). Conclusion: Low-dose propofol sedation was safe and recovery including driving ability was with 60 min.

“…Although several large clinical trials have recently demonstrated the safety of new drugs (e.g. propofol) under careful patient selection and conventional surveillance, there is still an ongoing debate on the risk that patients may unintentionally slide into a level of deep sedation or even anesthesia where vital functions may be seriously impaired [1, 7, 8, 9, 10, 11, 12, 13]. Many doubts regarding the use of these drugs by non-anesthesiologists (e.g.…”

Section: Introductionmentioning

confidence: 99%

Combined Pulse Oximetry/Cutaneous Carbon Dioxide Tension Monitoring during Colonoscopies: Pilot Study with a Smart Ear Clip

Heuss

Chhajed²,

Schnieper³

et al. 2004

Background: We compared the accuracy and practicability of a new combined ear sensor device measuring pulse oximetry and transcutaneous carbon dioxide tension. Methods: Validation studies were done by comparing the results of the combined sensor with arterial blood gas measurements. In an observational part, monitoring data were obtained from 25 patients undergoing colonoscopy, sedated with midazolam and alfentanil and from 8 patients without sedation. Results: There was an excellent correlation between the oxygen saturation and carbon dioxide tension measurements comparing the combined sensor with arterial blood gas analysis (R 0.96 and 0.93, respectively). A mean rise in transcutaneous carbon dioxide tension of 7.6 mm Hg was detectable during sedation with midazolam/alfentanil and of 2.3 mm Hg without sedation. Conclusion: Combined POX/PcCO₂ monitoring at the ear lobe is a novel approach to improve patient safety during sedation and may be helpful in preventing an unintentional slide into a state of deep sedation with impairment of ventilation.