Administered Propofol Sedation Research Articles

Implementation of nurse administered propofol sedation for same-day discharge pulsed field ablation of atrial fibrillation is safe and has excellent patient reviews

Abstract Background In June 2022, we introduced Pulsed Field Ablation (PFA) for de novo pulmonary vein isolation (PVI) in patients with atrial fibrillation (AF). Simultaneously, deep sedation with propofol undertaken by trained nurses from the cath lab was introduced. Purpose To evaluate feasibility, safety and patient reported experience for same-day discharge AF ablations performed with PFA on propofol sedation. Methods Patients with an ASA physical status classification of 1 or 2 referred for de novo AF ablation were planned for PFA in propofol sedation. Three nurses with previous experience from the intensive care unit planned and undertook the sedation. In addition, two nurses were trained locally. The initial 200 consecutive patients were included in the observational cohort study after signing consent to participate in follow-up after the procedure. Study data were collected and managed using REDCap electronic data capture tools. In addition to procedure related data, patient-reported quality measures were acquired 30 days after the procedure by an internet based questionnaire including scaling and open questions. Results 96% of the procedures were successfully completed using only propofol while 4% were scheduled for general anesthesia, mainly because of sleep apnea and high BMI. The average procedure time for the first 100 procedures was 57 min (95% CI, 54.1-62.9) and 45 min (95% CI, 42.6-47.4) for the following 100 procedures. Acute PVI was achieved during all procedures. No sedation related adverse effects were observed. One patient experienced pericardial tamponade requiring prolonged hospitalization. 87% were discharged on the same day as planned while 12% remained hospitalized one additional day for reassurance and social reasons. 93% (186/200) completed the questionnaire. 56% of patient only responded "very little" or "not at all" to all questions about adverse symptoms during and after the procedure. For each specific symptom, 80 to 95 % were only experienced "very little" or "not at all" (Fig 1). In general, patients felt safe about the preparation for and handling of the sedation (Fig 2). Conclusions Nurse administered deep sedation with propofol, provides excellent pain relief for PFA procedures, facilitates an efficient workflow and can safely be implemented and administered by nurses from the cath lab. Propofol sedation constitutes an important alternative to general anesthesia that is not widely available.Figure 1Figure 2

P350 Endoscopic sedation in IBD patients: a propensity score-matched retrospective study

Abstract Background Colonoscopy plays an essential role in the prevention of colorectal cancer screening and the management of inflammatory bowel disease (IBD). For patients with IBD, colonoscopy is advocated for detection of complications, guiding clinical decisions, and cancer surveillance. In most cases, sedation is a fundamental constituent of the procedure, reducing peri-procedural discomfort and improving examination quality. We aimed to compare the dosing of sedative medications and the duration of procedure for IBD patients compared to non-IBD controls in a large-volume endoscopic center. Methods This was a propensity score–matched retrospective study that took place at a high-volume gastroenterology department between June 2020 and September 2021. Colonoscopy data of patients with established IBD including medications and duration of procedure was collected, compared to a 1:2 propensity-scored matched cohort of non-IBD patients. Patients with polyposis, past abdominal surgery, known or suspected malignancy, suspected IBD, incomplete colonoscopies and colonoscopies with inadequate preparation were excluded. The sedation protocol in our institution includes an induction of Midazolam 1-2 mg and Fentanyl of 0.025-0.05 mg administered five minutes prior to procedure. An initial dose of 10-30 mg Propofol is initiated as well, with subsequent increments of 10-20 mg every 1-2 minutes, depending on sedation depth. Results During the study period, 14502 patients including 996 patients with IBD underwent colonoscopy and 4933 patients were excluded in accordance with the exclusion criteria. Propensity score matching was conducted using four characteristics - patient age, gender, American Society of anaesthesiologists score determined by the endoscopist, and endoscopists’ experience. A total of 2289 patients were included in the final analysis (763 IBD patients, 1526 control patients). The groups were similar in administered Propofol sedation doses [IBD- median dose of 100 mg, interquartile ratio (IQR) 70-150 vs control, 100 mg, IQR 80-150, p=0.2). In addition, total procedure time (considered the time from procedure start and end as recorded by the endoscopy nurse) was significantly longer in the IBD group (23 median minutes, IQR 18-30 vs 20 median minutes, IQR 16-27, p<0.0001). There were no differences in terminal ileum intubation rates between the groups (51% in IBD vs 49.5% in control, p=0.5). Conclusion In a retrospective analysis from a large-scale tertiary center cohort, colonoscopies of patients with IBD were significantly longer despite comparable terminal intubation rates; IBD patients did not require more intensive sedation than controls.

Efficacy and Safety of Deep Sedation and Anaesthesia for Complex Endoscopic Procedures-A Narrative Review.

Propofol sedation for advanced endoscopic procedures is a widespread technique at present, which generates controversy worldwide when anaesthetic or non-anaesthetic personnel administer this form of sedation. There is some evidence for safe administered propofol sedation by non-anaesthetic personnel in patients undergoing endoscopy procedures, but there are only few randomised trials addressing the safety and efficacy of propofol in patients undergoing advanced procedures. A serious possible consequence of propofol sedation is the rapid and unpredictable progression from deep sedation to general anaesthesia mostly when elderly and frail patients are involved in the diagnosis or treatment of various neoplasia. This situation requires rescue measures with skilled airway management. The aim of this paper is to review the safety and efficacy aspects of sedation techniques, with special reference to propofol administration covering the whole patient journey, including preassessment, sedation options and discharge when advanced endoscopic procedures are performed.

Patient Satisfaction of Propofol Versus Midazolam and Fentanyl Sedation During Colonoscopy in Inflammatory Bowel Disease

Colonoscopy is essential for optimal management of inflammatory bowel disease. However, many patients opt out due to unpleasantness related to this procedure. We investigated if Nurse Administered Propofol Sedation (NAPS) would improve patient satisfaction and attitude towards future colonoscopies. Randomized clinical trial of deep sedation with NAPS (n = 63) versus moderate midazolam and fentanyl sedation (n = 67). To assess the primary end point of patient satisfaction at discharge, we developed a Satisfaction Questionnaire comprising 13 items each rated by a 5-point Likert scale and with higher scores reflecting more positive outcomes (13-65 points). Fifty-six patients (43%) with ulcerative colitis, 48 (37%) with Crohn's disease, and 26 (20%) with high suspicion of inflammatory bowel disease were included. Most (88%) had previously had a colonoscopy and pre-procedure expectations were similar between groups. Patients receiving deep sedation had significantly higher satisfaction score (mean 60.1, SD 3.4) than those receiving moderate sedation (51.2, 8.4; P < .001). This was driven especially by less pain, more amnesia, sedation more to their liking, and better experience with the current than previous sedations. Importantly, these patients significantly more often preferred the same sedation for a future colonoscopy and were also inclined to accept more frequent colonoscopies. Assistance from another colonoscopist and disruption of the procedure due to pain occurred significantly more frequent in the moderate sedation group. There were no safety signals associated with NAPS. Patients with inflammatory bowel disease favor deep propofol sedation over moderate midazolam and fentanyl sedation. Availability of NAPS may facilitate patient adherence to endoscopy-based monitoring programs. Clinicaltrials.gov NCT01934088.

S0524 Safety Profile of Endoscopist-Directed Balanced Propofol Sedation for Procedural Sedation: An Experience at a Hospital-Based Endoscopy Unit

INTRODUCTION: Nurse administered propofol sedation was widely used for endoscopic procedures until 2009 when its use was restricted to anesthesiologists per CMS guidelines, a practice that has led to increases in healthcare costs. Aim was to evaluate the safety of endoscopist-directed balanced propofol sedation (EDBPS) for endoscopy. METHODS: We identified patients who underwent endoscopic procedures with EDBPS from Jan to Jun 2017. Medical records were abstracted for data on procedure indication, medication doses, time to induction of sedation, duration of procedure and recovery time. Adverse events (AEs) included: Hypoxia - oxygen saturation (SPO₂) 50 mm Hg, c) Drop in mean arterial pressure (MAP) > 30%; Bradycardia (heart rate < 40 beats/minute). Major complications include death, neurologic sequelae (CVA, permanent cognitive impairment), and need for hospitalization or endotracheal intubation. RESULTS: A total of 1897 patients received EDBPS during the study period. Mean age was 55 (SD 11.4) years and 43.6% were men. Patients received median doses of 50 mcg fentanyl and 2 mg of midazolam and a mean propofol dose of 160 ± 99 mg (range 20–960). Mean time for sedation induction was 3.4 (SD 1.9) and mean recovery was 14 (SD 10.2) min. There were no major complications (0%; 95% CI, 0–0.19%). Three hundred thirty-four patients (17.6%) experienced an AE, all of which were managed with simple measures (chin-lift, jaw thrust and increasing flow of O₂ and IV fluids): 65 (3.4%) had transient hypoxia, 277 (14.6%) had hypotension. In bivariate analysis, a 5-yr increase in patient age was associated with in increased risk of hypotension. A 50 mg increase in propofol dose was associated with a statistically significant risk of transient hypoxia. A 10-min increase in procedure duration was associated with statistically significant risk of both transient hypoxia and hypotension (Table 1). Age, weight, BMI, propofol dose and procedure length were associated with AEs (Table 2). Gender had no association with AEs. In multivariate analysis, only procedure length was independently associated with AEs. CONCLUSION: EDBPS is safe for endoscopic procedural sedation, as AEs occurred infrequently. Given the much higher cost of anesthesia-administered propofol for routine endoscopic procedures, endoscopists should re-instate EDBPS by revising institutional sedation policies.Table 1Table 2

Prospective audit of the safety of endoscopist-directed nurse-administered propofol sedation in an Australian referral hospital.

Endoscopist directed nurse administered propofol sedation (EDNAPS) is widely considered to be safe and efficient, but there are limited data from the Australian health-care setting, and Australian sedation guidelines do not support the practice. Thus, we report data from a prospective audit of EDNAPS over a 6.5-year period in an Australian referral hospital. Consecutive endoscopic procedures performed between January 2013 and June 2019. Sedation protocol was an initial dose of midazolam 1-3mg intravenously (i.v.) and propofol 10-50mg i.v.. Further aliquots of propofol 10-30mg i.v. were given as required. ProvationMD® endoscopic reporting system was used to prospectively record patient demographics, medication and dose, American Society of Anesthesiologist's (ASA) class, and sedation-related complications. During the 78-month period, 28051 eligible procedures were performed; 3093 procedures performed with anesthetic support or without EDNAPS were excluded. In total, 24958 procedures with EDNAPS were analyzed including 7563 gastroscopies, 12941 colonoscopies, 2932 gastroscopy and colonoscopy, 1440 flexible sigmoidoscopies, and 82 combined gastroscopy and flexible sigmoidoscopy. Of these, 9539 were ASA 1 (38.2%), 13680 were ASA 2 (54.8%), 1733 were ASA 3 (6.9%), and 4 were ASA 4 (0.02%). Sedation-related complications occurred in 66 patients (0.26%), predominantly transient hypoxic episodes. No patient required intubation for an airway emergency, and there was no sedation-related mortality. Sedation-related complications increased with ASA class and were significantly more common with gastroscopy. Endoscopist directed nurse administered propofol sedation is a safe way of performing endoscopic sedation in low-risk patients in the hospital setting.

1858 Corneal Injury After Routine Gastrointestinal (GI) Endoscopy With Moderate Sedation

INTRODUCTION: Corneal abrasion is the most common ocular adverse event from deep sedation and general anesthesia. Its occurrence during moderate sedation for gastrointestinal (GI) endoscopy has not been previously reported. We report 5 cases of corneal abrasion following standard GI endoscopy under moderate sedation. CASE DESCRIPTION/METHODS: Retrospective chart review of ocular adverse events during endoscopy collected prospectively from our endoscopy quality system. 5 cases were identified from May 2013 to January 2019. All patients (4 men, 1 woman; age 45-76) underwent routine endoscopy (2 upper endoscopies, 2 colonoscopies, 1 upper endoscopy and colonoscopy) and noted ocular discomfort during recovery from the procedure. All procedures were performed under moderate sedation with 4 patients receiving non-anesthesiologist administered propofol sedation in our hospital endoscopy lab and the 5th patient receiving monitored anesthesia care (MAC) propofol sedation in the medical ICU. Procedure times ranged from 15 minutes to 2 hours 18 minutes. Oxygenation methods included two by nasal cannula (4L/min and 6L/min), two by non-rebreather mask (12 L/min), and one by Bilevel positive airway pressure mask (BiPAP). Ophthalmological examination confirmed the presence of a corneal abrasion in all cases. No patients had prior ocular disease or injury. DISCUSSION: Moderate sedation for GI endoscopy is very safe, but there exists a risk for corneal injury which has not been previously reported. Endoscopists and unit staff should be made aware of this complication, which is likely underrecognized. Training to ensure patient’s eyelids are fully closed during procedure, supplemental oxygen delivery systems are properly fitted and that there is no direct contact between the dependent eye and underlying head support can prevent this complication.

Sedation practices in gastrointestinal endoscopy—A survey from southern India

Gastrointestinal endoscopies can cause an unpleasant experience for the patient. In India, most endoscopists follow a common institutional policy for sedation. The aim of this study was to analyze the sedation practices in various endoscopy centers across southern India. Data were collected with the help of a structured questionnaire given to a senior endoscopist of the center. Data from the completed questionnaire were later analyzed. Data were obtained from 19 centers across southern India. All endoscopy suites had central oxygen supply and emergency cart. A defibrillator was available in 12 centers (63.2%). Common criteria followed for administering sedation included therapeutic procedures (84.2%), patients who requested sedation (63.2%), children (63.2%), high-risk procedures (57.9%), and uncooperative patients (57.9%). Monitoring methods included pulse oximetry alone in six centers (31.6%), pulse oximetry with blood pressure monitoring in five centers (26.3%), and pulse oximetry, blood pressure, and electrocardiography (ECG) monitoring in eight centers (42.1%). For advanced procedures like endoscopic ultrasonography (EUS) and endoscopic retrograde cholangiopancreatography (ERCP), sedation was universally used. An anesthesiologist was available in the endoscopy suite in eight centers (42.1%). Five endoscopists administered propofol sedation without anesthesiologist's presence (26.3%). Thirteen centers had a written protocol for pre-procedure risk assessment (68.4%). A dedicated post-procedure observation area was available in seventeen centers (89.5%). Seven centers followed a written post-sedation discharge protocol (36.8%). Significant variations exist in the practice of sedation among endoscopists in southern India. There is an urgent need to formulate guidelines by endoscopy societies for ensuring better patient outcomes in endoscopy.

63 Nurse Administered Propofol Sedation (NAPS) Is More Efficient than Anaesthesiologist Administered Sedation With Propofol (AAP) for Endoscopic Procedures in Patients at Low-Intermediate Anesthetic Risk

63 Nurse Administered Propofol Sedation (NAPS) Is More Efficient than Anaesthesiologist Administered Sedation With Propofol (AAP) for Endoscopic Procedures in Patients at Low-Intermediate Anesthetic Risk

Mo1688 - The Safety of Endoscopist Directed Nurse Administered Propofol Sedation (EDNAPS) for Endoscopic Procedures in a Regional Hospital Setting

Mo1688 - The Safety of Endoscopist Directed Nurse Administered Propofol Sedation (EDNAPS) for Endoscopic Procedures in a Regional Hospital Setting

Safety of non-anesthesia provider administered propofol sedation in non-advanced gastrointestinal endoscopic procedures: A meta-analysis.

Background/Aims:The aim of the study was to evaluate the safety of non-anesthesia provider (NAPP) administered propofol sedation in patients undergoing non-advanced gastrointestinal (GI) endoscopic procedures.Materials and Methods:Pubmed, Embase, Cochrane central register of controlled trials, Scopus, and Web of Science databases were searched for prospective observational trials involving non-advanced endoscopic procedures. From a total of 608 publications, 25 [colonoscopy (9), upper GI endoscopy (5), and combined procedures (11)] were identified to meet inclusion criteria and were analyzed. Data was analyzed for hypoxia rates, airway intervention rates, and airway complication rates.Results:A total of 137,087 patients were involved. A total of 2931 hypoxia episodes (defined as an oxygen saturation below 90%) were reported with a pooled hypoxia rate of 0.014 (95% CI being 0.008-0.023). Similarly, pooled airway intervention rates and pooled airway complication rates were 0.002 (95% CI being 0.006–0.001) and 0.001 (95% CI being 0.000–0.001), respectively.Conclusions:The rates of adverse events in patients undergoing non-advanced GI endoscopic procedures with NAPP sedation are extremely small. Similar data for anesthesia providers is not available. It is prudent for anesthesia providers to demonstrate their superiority in prospective randomized controlled trials, if they like to retain exclusive ownership over propofol sedation in patients undergoing GI endoscopy.

Sedation for routine gastrointestinal endoscopic procedures: a review on efficacy, safety, efficiency, cost and satisfaction.

Most gastrointestinal endoscopic procedures are now performed with sedation. Moderate sedation using benzodiazepines and opioids continue to be widely used, but propofol sedation is becoming more popular because its unique pharmacokinetic properties make endoscopy almost painless, with a very predictable and rapid recovery process. There is controversy as to whether propofol should be administered only by anesthesia professionals (monitored anesthesia care) or whether properly trained non-anesthesia personnel can use propofol safely via the modalities of nurse-administered propofol sedation, computer-assisted propofol sedation or nurse-administered continuous propofol sedation. The deployment of non-anesthesia administered propofol sedation for low-risk procedures allows for optimal allocation of scarce anesthesia resources, which can be more appropriately used for more complex cases. This can address some of the current shortages in anesthesia provider supply, and can potentially reduce overall health care costs without sacrificing sedation quality. This review will discuss efficacy, safety, efficiency, cost and satisfaction issues with various modes of sedation for non-advanced, non-emergent endoscopic procedures, mainly esophagogastroduodenoscopy and colonoscopy.

Safety Analysis of Bariatric Patients Undergoing Outpatient Upper Endoscopy with Non-Anesthesia Administered Propofol Sedation.

Non-anesthesia administered propofol (NAAP) has been shown to be a safe and effective method of sedation for patients undergoing gastrointestinal endoscopy. Bariatric surgery patients are potentially at a higher risk for sedation-related complications due to co-morbidities including obstructive sleep apnea. The outcomes of NAAP in bariatric patients have not been previously reported. In this retrospective cohort study, severely obese patients undergoing pre-surgical outpatient esophagogastroduodenoscopy (EGD) were compared to non-obese control patients (BMI≤25kg/m2) undergoing diagnostic EGD at our institution from March 2011-September 2015 using our endoscopy database. Patients' demographics and procedural and recovery data, including any airway interventions, were statistically analyzed. We included 130 consecutive pre-operative bariatric surgical patients with average BMI 45.8kg/m2 (range 34-80) and 265 control patients with average BMI 21.9kg/m2 (range 14-25). The severely obese group had a higher prevalence of sleep apnea (62 vs 8%; p<0.001), experienced more oxygen desaturations (22 vs 7%; p<0.001), and received more chin lift maneuvers (20 vs 6%; p<0.001). Advanced airway interventions were rarely required in either group and were not more frequent in the bariatric group. With appropriate training of endoscopy personnel, NAAP is a safe method of sedation in severely obese patients undergoing outpatient upper endoscopy.

How patient-controlled sedation is adopted in clinical practice of sedation for endoscopic retrograde cholangiopancreatography? A prospective study of 1196 cases

Objective: Patient-controlled sedation (PCS) has been shown to be a valid choice for sedation during endoscopic retrograde cholangiopancreatography (ERCP) in randomized studies. However, large-scale studies are lacking.Material and methods: A single center, prospective observational study to determine how sedation for ERCP is administered in clinical setting. All 956 patients undergoing 1196 ERCPs in the endoscopy unit of Helsinki University Central Hospital 2012–2013, methods of sedation and adverse events associated with different sedations were recorded.Results: PCS was attempted a total of 685 times (57%), successful use of PCS was achieved with 526 patients (77% of attempts). PCS device was operated by the anesthesiologist or anesthesia nurse 268 times (22%). PCS was more likely chosen for younger (80.6% for < =60 years vs. 63.8% for >60 years, p<.001) patients and by trainee anesthetists. Anesthesiologist administered propofol sedation was used 240 times (20%). The risk of failure of PCS was increased, if systolic arterial pressure was <90 mmHg, dosage of PCS >17 ml, duration of procedure exceeded 23 min. The risk of failure was lower in patients with primary sclerosing cholangitis (PSC) and if sedation was deeper RASS < =−2. Uneventful PCS was associated with less respiratory and cardiovascular depression than other methods. There were no statistically significant differences in safety profiles with all the methods of sedation.Conclusions: PCS is readily implemented in clinical practice, is suitable for younger and low-risk patients and is associated with less cardiorespiratory adverse effects.

SafAIRway: an airway training for pulmonologists performing a flexible bronchoscopy with nonanesthesiologist administered propofol sedation: A prospective evaluation.

Nonanesthesiologist administered propofol (NAAP) sedation for flexible bronchoscopy is controversial, because there is no established airway management (AM) training for pulmonologists. The aim was to investigate the performance and acceptance of a proposed AM algorithm and training for pulmonologists performing NAAP sedation. The algorithm includes using 3 maneuvers including bag mask ventilation (BMV), laryngeal tube (LT), and needle cricothyrotomy (NCT). During training (consisting of 2 sessions with a break of 9 weeks in between), these maneuvers were demonstrated and exercised, followed by 4 consecutive attempts to succeed with each of these devices. The primary outcome was the improvement of completion time needed for a competent airway. Secondary outcomes were the trainees' overall reactions to the training and algorithm, and the perceptions of psychological safety (PS). The 23 staff members of the Department of Pulmonology performed a total of 552 attempts at AM procedures (4 attempts at each of the 3 maneuvers in 2 sessions), and returned a total of 42 questionnaires (4 questionnaires were not returned). Median completion times of LT and NCT improved significantly between Sessions 1 and 2 (P = 0.005 and P = 0.04, respectively), whereas BMV was only marginally improved (P = 0.05). Trainees perceived training to be useful and expressed satisfaction with this training and the algorithm. The perception of PS increased after training. An AM algorithm and training for pulmonologists leads to improved technical AM skills, and is considered useful by trainees and raised their perception of PS during training. It thus represents a promising program.

Mo1964 Safety Analysis of Bariatric Patients Undergoing Outpatient Upper Endoscopy With Nurse Administered Propofol Sedation

Mo1964 Safety Analysis of Bariatric Patients Undergoing Outpatient Upper Endoscopy With Nurse Administered Propofol Sedation

Is capnography mandatory during sedation for endoscopy?

Is capnography mandatory during sedation for endoscopy?

1053 A Comparison of Propofol Sedation by an Anesthesiologist Versus A Gastroenterologist-Led Team Using the SEDASYS® System

The past 5 to 7 years has seen a dramatic rise in anesthesiologist administered propofol sedation in healthy adult patients undergoing routine endoscopy procedures. Many gastroenterologists may attribute this rise to the benefits of propofol, while others may attribute the rise to the benefits of an anesthesiologist. This study was designed to see if there is a difference in propofol sedation by an anesthesiologist versus a gastroenterologist-led team using the SEDASYS® System.

A survey of procedural sedation for pediatric gastrointestinal endoscopy in India.

Sedation practices for pediatric gastrointestinal endoscopic procedures (PGEP) vary based on infrastructure, availability of trained personnel, and local protocols. Data on prevalent sedation practices is lacking from India. This study aimed to survey the sedation practices for PGEP in India. A mailing list was constituted with the e-mail addresses of the members of the Indian Society of Pediatric Gastroenterology, Hepatology and Nutrition, Indian Academy of Pediatrics, Association of Surgeons of India, Indian Association of Pediatric Surgeons, and Indian Society of Gastroenterology. The web-based survey was sent by e-mail. Of the 498 recipients, who responded through the survey link, 91 did not complete the survey. Among those who completed the survey, 91 performed PGEP. Among these 91, 12.1 % performed PGEP without sedation or general anesthesia. Anesthetist involvement was associated with use of propofol based-sedation. Of the respondents, 70.3 % found non-anesthetist administered propofol sedation unacceptable while 38.5 % of the centers had a policy against it. Two-thirds of the respondents were assisted by an anesthetist for most PGEP. An operating room (OR) was used for PGEPs by 23.1 %. PGEP in a non-teaching hospital, non-availability of pediatrician in the endoscopy room, use of an OR for PGEP, and the easy availability of an anesthetist were strongly associated with the involvement of an anesthetist. The survey indicates a high frequency of involvement of anesthetists and use of OR. This survey should serve as an impetus to evaluate the cost of PGEP in India and the training accorded to non-anesthetists for procedural sedation.

Current role of non-anesthesiologist administered propofol sedation in advanced interventional endoscopy.

Complex and lengthy endoscopic examinations like endoscopic ultrasonography and/or endoscopic retrograde cholangiopancreatography benefit from deep sedation, due to an enhanced quality of examinations, reduced discomfort and anxiety of patients, as well as increased satisfaction for both the patients and medical personnel. Current guidelines support the use of propofol sedation, which has the same rate of adverse effects as traditional sedation with benzodiazepines and/or opioids, but decreases the procedural and recovery time. Non-anesthesiologist administered propofol sedation has become an option in most of the countries, due to limited anesthesiology resources and the increasing evidence from prospective studies and meta-analyses that the procedure is safe with a similar rate of adverse events with traditional sedation. The advantages include a high quality of endoscopic examination, improved satisfaction for patients and doctors, as well as decreased recovery and discharge time. Despite the advantages of non-anesthesiologist administered propofol, there is still a continuous debate related to the successful generalization of the procedures.