Propofol Sedation For Gastrointestinal Endoscopy Research Articles

Effect of Aminophylline on Incidence of Apnea and Recovery Time during ‎Propofol Sedation for ‎Gastrointestinal Endoscopy

Effect of Aminophylline on Incidence of Apnea and Recovery Time during ‎Propofol Sedation for ‎Gastrointestinal Endoscopy

Development and validation of a theoretical test in non-anaesthesiologist-administered propofol sedation for gastrointestinal endoscopy

Objective: Safety with non-anaesthesiologist-administered propofol sedation (NAAP) during gastrointestinal (GI) endoscopy is related to theoretical knowledge. A summative testing of knowledge before attempting supervised nurse-administered propofol sedation (NAPS) in the clinic is advised. The aims of this study were to develop a theoretical test about propofol sedation, to gather validity evidence for the test and to measure the effect of a NAPS-specific training course.Material and methods: A three-phased psychometric study on multiple choice questionnaire (MCQ) test development, gathering of validity evidence and evaluation of the effect of a specific NAAP course on the test result. A MCQ containing 86 questions was developed and administered 113 times to 91 participants representing novices, intermediates and experienced.Results: Question difficulty analyses revealed 50 level I and II questions. The 50 MCQs showed mean (SD) intergroup differences (p = 0.001) between novices = 28.6 (4.82), intermediates = 36.8 (5.43) and experienced = 41.8 (4.65) and provided a pass score of 35.2. The course with pre-course test had significant effect on the knowledge of nurses (18% increase) and physicians (19% increase; p = 0.001 and 0.001, respectively).Conclusions: Data supported the validity of the developed MCQ test. The NAPS-specific course with pre-course testing adds theoretical knowledge to already well-prepared participants.

Sedation-Associated Complications in Endoscopy - Prospective Multicentre Survey of 191142 Patients

Propofol sedation is applied as moderate sedation for almost all diagnostic and interventional endoscopies. Propofol sedation bears the risk of complications such as respiratory as well as cardiopulmonary insufficiency including sedation-induced death. According to recent guidelines, non-anesthesiologist-administered propofol (NAAP) should be performed by an additional person who has NAAP as their sole task. In a prospective multicentre survey involving 191,142 patients, clinically relevant endoscopy-associated complications were registered from 02/2010 to 01/2012. The majority of propofol sedations were applied without additional persons for NAAP. Overall endoscopy-related complication rate was 0.0022 % (n = 424) and sedation-related complications 0.00 042 % (n = 82). Variability over time and between the clinics was low and not influenced by the number of endoscopies performed during the investigation period. Sedation-related death occurred in 6 patients (0.00 003 %), 50 % during emergency endoscopies. In all sedation-associated deaths the patients had ASA class 3 before endoscopy. All fatal complications occurred in the presence of an additional trained person for NAAP. This large prospective survey shows that propofol sedation in gastrointestinal endoscopy is a safe procedure with a low potential of risk in daily routine. However, high risk patients (ASA ≥ 3) should be identified, especially before emergency endoscopies and managed by additional persons for NAAP and under intensive care surveillance.

The Use of Propofol as a Sedative Agent in Gastrointestinal Endoscopy: A Meta-Analysis

ObjectivesTo assess the efficacy and safety of propofol sedation for gastrointestinal endoscopy, we conducted a meta-analysis of randomized controlled trials (RCTs) comparing propofol with traditional sedative agents.MethodsRCTs comparing the effects of propofol and traditional sedative agents during gastrointestinal endoscopy were found on MEDLINE, the Cochrane Central Register of Controlled Trials, and EMBASE. Cardiopulmonary complications (i.e., hypoxia, hypotension, arrhythmia, and apnea) and sedation profiles were assessed.ResultsTwenty-two original RCTs investigating a total of 1,798 patients, of whom 912 received propofol only and 886 received traditional sedative agents only, met the inclusion criteria. Propofol use was associated with shorter recovery (13 studies, 1,165 patients; WMD –19.75; 95% CI –27.65, 11.86) and discharge times (seven studies, 471 patients; WMD –29.48; 95% CI –44.13, –14.83), higher post-anesthesia recovery scores (four studies, 503 patients; WMD 2.03; 95% CI 1.59, 2.46), better sedation (nine studies, 592 patients; OR 4.78; 95% CI 2.56, 8.93), and greater patient cooperation (six studies, 709 patients; WMD 1.27; 95% CI 0.53, 2.02), as well as more local pain on injection (six studies, 547 patients; OR 10.19; 95% CI 3.93, 26.39). Effects of propofol on cardiopulmonary complications, procedure duration, amnesia, pain during endoscopy, and patient satisfaction were not found to be significantly different from those of traditional sedative agents.ConclusionsPropofol is safe and effective for gastrointestinal endoscopy procedures and is associated with shorter recovery and discharge periods, higher post-anesthesia recovery scores, better sedation, and greater patient cooperation than traditional sedation, without an increase in cardiopulmonary complications. Care should be taken when extrapolating our results to specific practice settings and high-risk patient subgroups.

Protected: Challenging Propofol Sedation in Gastrointestinal Endoscopy: High Risk Patients and High Risk Procedures

Sedation is increasingly becoming a must for most endoscopic procedures. Non-anesthesiologist administration of propofol is the standard of practice in many European countries. Nevertheless, despite anesthesiology societies concerns about sedation guided by endoscopist, practitioners find some limits to propofol administration, related to high risk patients or high risk and complex procedures, which can be long lasting and technically challenging. The main patient related risk factors for sedation are elderly patients, obesity, ASA≥3 patients, individuals with craniofacial abnormalities or with pharyngolaringeal tumors, patients with an acute gastrointestinal bleeding, under pain medications, sedatives, antidepressants, or who consume significant amounts of alcohol or drugs. Procedure related risk factors have more to do with the duration and complexity of the procedure than with other factors, in which considering a general anesthesia allows the endoscopist to concentrate on a difficult task. Published papers addressing the most challenging sedation groups in endoscopy are exploring and even trespassing previously assumed frontiers, and new scenarios are opening to the endoscopist, increasing his/her autonomy, reducing costs and giving patients levels of comfort previously unknown. In this review we analyse each risk group determining the ones in which a sedation protocol could be widely applied, and other in which the published evidence does not guarantee a safe endoscopist guided propofol sedation.

A Much Sought-After Drug—Propofol Sedation for GI Endoscopy: Always Better but Who Cares?

Several hypnotic and analgesic strategies have beendevised for patients undergoing gastrointestinal (GI)endoscopy, ranging in a continuum from mild conscioussedation to general anesthesia.Endoscopic retrograde cholangiopancretography (ERCP)and endoscopic ultrasound (EUS) are particularly unpleas-ant diagnostic procedures for patients and more time con-suming than any other endoscopic procedure. Moreover,ERCP can be technically difficult and requires completepatient cooperation in order to be safely and successfullycompleted. Patients frequently are sedated for ERCP orEUS with intravenous bolus doses of benzodiazepines incombination with opioids, which are meant to improve thequality of sedation by providing analgesia. Deep sedation issometimes required.The introduction of propofol into clinical practice sig-nificantly changed the attitudes of both physicians andpatients towards sedation, with the result that propofolsedation for GI endoscopy has become common practiceworldwide. In recent years, propofol has been safely andeffectively used in advanced interventional endoscopicprocedures, such as ERCP and EUS, even for high-riskpatients [1]. Propofol is a hypnotic drug with rapid onsetand offset of action. Used as a single agent, it is commonlytitrated to attain deep sedation, whereas balanced propofolsedation (BPS), in which propofol use is associated withsmall doses of benzodiazepines and/or opioids, can besuccessfully titrated to attain moderate sedation.Several studies have shown that, when compared withconventional sedation, BPS with propofol, midazolam,and/or meperidine, yields higher physician and patientsatisfaction, better patient cooperation, and similar com-plication rates in patients undergoing therapeutic endo-scopic procedures. The total propofol dose may beexpected to be reduced by 50 % with BPS in comparisonwith propofol alone sedation.A critical advantage in dealing with BPS for moderatesedation is that it can be partially reverted, since antagonistsare available against both opioids and benzodiazepines.In the current issue of Digestive Diseases and Sciences,Tae Hoon Lee et al. [2] present the results of a randomizedprospective study comparing BPS (propofol, midazolam,and fentanyl) with propofol alone during moderate sedationfor ERCP and EUS. The authors demonstrate that propofolalone provides a shorter recovery time than BPS and iscomparably effective and safe. This paper is the naturalevolution of a previous study of the same authors in whichthey demonstrated a higher safety and efficacy of BPS incomparison with conventional sedation [3]. In this respect,Tae Hoon Lee et al. positively contribute to the knowledgeof sedation strategies for endoscopy.However, in another respect, they quietly and almostinadvertently hit a raw nerve in the ongoing debate aboutwho can/should provide propofol sedation. In both of theirstudies, sedation was provided by non-anesthesiologists,further adding to the body of literature indicating that theadministration of propofol by non-anesthesiologists may besafe and effective for selected patients undergoingadvanced endoscopic procedures.The subject of non-anesthesiologist administrationof propofol (NAAP), particularly for endoscopy, has

Propofol Use for Sedation during Endoscopy in Adults: A Canadian Association of Gastroenterology Position Statement

Over the past decade, multiple clinical reports have demonstrated that the use of propofol sedation for gastrointestinal endoscopy by gastroenterologists and trained endoscopy nurses is safe and effective in appropriately selected patients. Proposed benefits of propofol sedation include rapid onset of action, improved patient comfort and rapid clearance, as well as prompt recovery and discharge from the endoscopy unit. As a result of medical evidence, a number of international professional societies have endorsed the use of propofol in gastrointestinal endoscopy. In Canada, no formal guidelines currently exist. In the present article, the Clinical Affairs Committee of the Canadian Association of Gastroenterology presents a position statement, incorporating updated information on the use of propofol sedation for endoscopy in adult patients.

Propofol Sedation During Endoscopic Procedures: How Much Staff and Monitoring Is Necessary?

Background: Propofol has been shown to be safe for non-anesthetist use during gastrointestinal endoscopy. However, published studies involved propofol administration by an additional nurse and/or used specialized patient monitoring and/or were carried out in tertiary hospitals. Considering the downward pressure on reimbursement for endoscopic procedures, we asked the question how much staff and monitoring is necessary for a safe use of propofol in a practice setting. Methods: More than 27,000 endoscopic procedures (14,856 esophagogastroduodenoscopies (EGD) and 12,205 colonoscopies) performed in two private gastroenterology practices were prospectively assessed regarding patient characteristics, ASA status, dosage of propofol, fall of oxygen saturation below 90%, need to increase nasal oxygen administration above 2 l/min, and need for assisted ventilation. Propofol was administered by the endoscopy nurse supervised by the endoscopist. Patient monitoring consisted of only pulse oximetry and clinical assessment. Results: The mean propofol dose for EGD was 161 mg (range 50-650). During colonoscopy patients received a mean propofol dose of 116 mg (30-500) in addition to 25 mg meperidine. Oxygen saturation fell below 90% (lowest 74%) in 623 procedures (2.3%), normalizing within less than 30 seconds by stimulating the patient and increasing the nasal oxygen flow to 4-10 L/min. Six patients (ASA III) required mask ventilation for less than 30 seconds. No endotracheal intubation was necessary. Conclusions: An endoscopy team, consisting of one physician endoscopist and one endoscopy nurse, can safely administer propofol sedation for gastrointestinal endoscopy in a practice setting without additional staff or specialized monitoring.

Propofol Sedation for Gastrointestinal Endoscopy Administered by Nursing Staff Under Gastroenterologist Supervision

Propofol Sedation for Gastrointestinal Endoscopy Administered by Nursing Staff Under Gastroenterologist Supervision

Propofol sedation in gastrointestinal endoscopy: evaluation of recovery times and safety compared to Standard Conscious Sedation

Propofol sedation in gastrointestinal endoscopy: evaluation of recovery times and safety compared to Standard Conscious Sedation