Mo1110 PATIENT AND ENDOSCOPIST SATISFACTION WITH NURSE ADMINISTERED PROPOFOL CONTINUOUS INFUSION SEDATION: A COMPARATIVE STUDY AGAINST MIDAZOLAM/FENTANYL AND COMPUTER ASSISTED PROPOFOL SEDATION

Abstract

As the first U.S. center to adopt computer assisted propofol sedation (CAPS) for routine clinical use, we found it to be an effective, efficient and safe method to administer sedation that was very well received by our patients, nurses and endoscopists. After the closure of the CAPS manufacturer in 2016, we developed Nurse Administered Propofol Continuous Infusion Sedation (NAPCIS), a method to replicate the CAPS dosing protocol in the absence of the CAPS device. NAPCIS is a propofol delivery method that uses a standard IV infusion pump controlled by a trained nurse, with a dosing and safety protocol identical to that used in CAPS. Instead of small, intermittent propofol boluses, a continuous infusion is given after a single fentanyl premedication dose. This abstract reports patient and endoscopist satisfaction with NAPCIS compared against 2 control groups - CAPS and midazolam/fentanyl (MF) sedation. Patients who underwent elective outpatient upper endoscopy and colonoscopy with NAPCIS over a 2 month period were compared against historical controls sedated with MF or CAPS. All endoscopy was performed by 1 of 19 specially trained gastroenterologists. Patient satisfaction was measured by the validated 19-item Patient Sedation Satisfaction Index (PSSI), and endoscopist satisfaction by the 21-item Clinician Sedation Satisfaction Index (CSSI); the PSSI and CSSI incorporate subscores for the assessment of sedation adequacy, ease of sedation administration, the recovery process and global satisfaction. Normalized satisfaction scores (scale of 1-100) were compared between NAPCIS and CAPS or MF controls, stratified by procedure type. Procedural success rates, polyp detection rates, adverse events, and procedure/recovery times are reported in a separate abstract. NAPCIS was used to sedate 236 patients (mean age 57.8 years; 48.5% male), of whom 46 underwent upper endoscopies and 190 colonoscopies. Their satisfaction scores were compared against 298 MF and 228 CAPS controls. For both colonoscopy and upper endoscopy, the NAPCIS group had higher PSSI subscores than the MF controls for sedation adequacy, the recovery process, and global satisfaction (Table 1), and much higher CSSI subscores for ease of sedation administration, the recovery process, and global satisfaction (Table 2). PSSI scores were comparable between NAPCIS and CAPS for colonoscopy but were higher for NAPCIS for upper endoscopy (data not shown). CSSI scores were significantly higher for NAPCIS compared against CAPS for both upper endoscopy and colonoscopy (data not shown). Compared against MF, NAPCIS is associated with uniformly higher patient and endoscopist satisfaction for both upper endoscopy and colonoscopy. Compared against CAPS, NAPCIS is associated with higher patient and endoscopist satisfaction for upper endoscopy but not for colonoscopy.Tabled 1Table 1. PSSI subscores: NAPCIS vs MF (higher scores denote higher satisfaction)EGDColonoscopyNAPCISMFPNAPCISMFPSedation Adequacy97.291.7<0.00196.889.9<0.001Recovery Process96.492.4<0.00194.590.1<0.001Global Satisfaction97.995.40.03396.393.7<0.001 Open table in a new tab Tabled 1Table 2. CSSI subscores: NAPCIS vs MF (higher scores denote higher satisfaction)EGDColonoscopyNAPCISMFPNAPCISMFPEase of Sedation Administration95.781.8<0.00198.085.2<0.001Recovery Process97.769.2<0.00198.175.4<0.001Global Satisfaction94.878.6<0.00198.083.8<0.001 Open table in a new tab