Assessing the safety of physician-directed nurse-administered propofol sedation in low-risk patients undergoing endoscopy and colonoscopy

Abstract

Background and study aims Physician-directed nurse-administered balanced propofol sedation (PhD NAPS) in patients undergoing endoscopy and/or colonoscopy is being increasingly utilized worldwide. However, this method of sedation is not universally employed in Australian hospitals due to concerns surrounding its safety. The aim of this study was to assess the safety of PhD NAPS in low-risk patients undergoing endoscopy and/or colonoscopy. Patients and methods This study was conducted at a single tertiary teaching hospital in Adelaide, Australia. It was a prospective study involving 1000 patients with an ASA score of 1 – 3 presenting with any indication for endoscopy, colonoscopy or both. A total of 981 patients (451 male) with a mean age of 53 years (range: 16 – 87) were recruited from January 2010 to October 2012. 440 endoscopies, 420 colonoscopies, and 121 combined procedures were performed. The intra-procedural adverse events (AEs) were recorded. Results There were no major intra-procedural adverse events. Minor AEs occurred in 6.42 % of patients, and resolved spontaneously or with intravenous fluid boluses in all cases. Conclusion PhD NAPS is safe when the proceduralist and nursing staff are adequately trained and strict patient selection criteria are used.

Sedation for Colonoscopy: Comparison of Remifentanil and Alfentanil Combined with Propofol/Midazolam

“…Drug-induced hypoventilation may cause hypoxemia and carbon dioxide retention. Pulse-oximetry is a useful indicator of oxygenation (21). When propofol is administered concomitantly with an opioid, it causes less respiratory depression (8).…”

“…Also, a more profound fall in blood pressure may occur in the hypovolemic patient. Volume support can be beneficial; therefore, it can be suggested in order to prevent hypotension due to propofol (21).…”

Use of diphenhydramine as an adjunctive sedative for colonoscopy in patients on chronic opioid therapy: a randomized controlled trial

“…Our argument is further supported by earlier studies that have shown that although propofol has a more rapid onset of action and shorter recovery time than do traditional sedatives, it does not improve other clinically important outcomes. [25][26][27] Although the present study is unique in that it explores the utility of adjunct sedatives in a difficult-to-sedate patient population, it is not without limitations. We recruited only veterans; therefore, the main limitation is that most of our patients were white males.…”

Are Gastrointestinal Endoscopic Procedures Performed by Anesthesiologists Safer Than When Sedation is Given by the Endoscopist?

“…There have been multiple previous publications comparing an expanded class of AEs when using anesthesia, primarily with propofol assistance for endoscopic procedures compared with endoscopist-given sedation using midazolam and fentanyl. [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] In one, Cooper et al 6 reviewed a random sample of 5% of all Medicare patients undergoing colonoscopy without polypectomy in 1 of the regions served by the Surveillance, Epidemiology, and End Results registry. These authors reviewed 165,527 procedures, 21.2% of which were done with anesthesia services.…”