Safety Profile of Endoscopist-Directed Sedation with Propofol in a Community Setting

Abstract

Purpose: Most endoscopic procedures in the United States(US) are performed using endoscopist- directed benzodiazepines and opioid administration. More recently, deep sedation with Propofol has been used in the US but is generally managed by anaesthesiologists. Compared to conscious sedation, deep sedation with Propofol is associated with lower or comparable rates of adverse events, higher post-procedure patient satisfaction, faster sedation and recovery time. Professional societies have released position statements endorsing the administration of Propofol by non-anesthesiologists. Methods: This is a multicenter retrospective study evaluating data from a total of 5 sites in the community setting in the United States from 01/1999 to 04/2012. All the procedures were elective cases performed by gastroenterologists in an ambulatory surgery unit. All personnel (endoscopist, RN and LPN) involved in the procedure were ACLS certified and educated on Propofol administration, airway management annually by a board certified anesthesiologist. Results: A total of 102,143 procedures (39,450 EGDs and 62,693 colonoscopies) were performed at 5 sites. Most of the patients were ASA class I or II with few being ASA class III. There were no deaths or permanent neurological injuries. There was 1 (0.0009%) cardiac complication. The overall number of cases needing Ambu bag assists were 8 (0.0079%) and transfer for acute care were 4 (0.0039%).Table: [1452] Adverse eventsConclusion: Endoscopist-directed deep sedation with Propofol during elective procedures in a community setting is safe. In ASA I & II patients, Propofol can be safely administered by trained endoscopists and nurses without the presence of an anesthesiologist, which would lead to substantial cost saving.