EFFICACY AND SAFETY OF NURSE-ADMINISTERED PROPOFOL AS AN ADJUNCTIVE AGENT OF CONSCIOUS SEDATION IN PRIVATE NON-ACEDEMIC GASTROENTEROLOGY PRACTICE SETTING

Abstract

Purpose: This study evaluates the safety and efficacy of propofol (P) in a private non-academic setting. Special interest was paid in a subset of patients who take chronic psychotropic/pain medications (cpm) (i.e. antidepressants, anxiolytics, pain meds, etc.) and who generally tend to need higher doses of conventional medication. Methods: All endoscopy nurses were given educational material designed by our ambulatory endoscopy center and were required to take a self-evaluation test. P was used as an adjunct to conventional sedation, namely midazolam (M), meperidine (MP), and fentanyl (F) and was administered by a R.N. supervised by board certified gastroenterologist. The endpoints measured were: 1) was there adequate sedation that led to a successful procedure? 2) what were the major (i.e. endotracheal intubation, bag-mask ventilation) versus minor (i.e. rash) complications? 3) can P be safely administered without an anesthesia specialist present in a private non-academic setting? 4) was a higher dose of P needed for adequate sedation in patients who are on cpm? Results: P was used in combination with conventional agents in 254 patients who underwent endoscopy. All patients in this study were ASA I-III classification. The range of P, M, MP, and F used in all patients was 5 mg-90 mg, 1 mg-5 mg, 12.5 mg-75 mg, and 25 mcg-100 mcg, respectively. The patients were divided into two groups, those on cpm (123 patients) and those who are not (131 patients). The results for those patients on cpm are as follows: the average dose of P, M, MP, and F is 22.28 mg, 3.35 mg, 45.25 mg, and 88.9mcg, respectively. The results for patients not on cpm are as follows: the average dose of P, M, MP, and F is 22.67 mg, 3.64 mg, 47.67 mg, and 70.0mcg, respectively. There were no major complications and 1 minor complication (rash). No patients required special airway intervention such as endotracheal intubation or bag-mask ventilation. Five patients had a temporary Sa02 of <90% after administration of P with spontaneous resolution. Conclusions: Propofol sedation in conjunction with conventional agents is overall safe and effective when used in a private non-academic setting. This held true even in patients who are on cpm. In our study, patients who are on cpm tended towards lower dosage of conventional medications and do not need higher doses of P compared to the other group. This indicates that P has the potential of reducing the dose of conventional medications in patients who are known to require higher doses in general.