Comparison of Differing Sedation Practice for Upper Endoscopic Ultrasound Using Expert Observational Analysis of the Procedural Sedation

Abstract

Expert videotape analysis of the patient state during procedural sedation allows direct comparison of sedation methodologies using small numbers of patients. In our institution, endoscopist-directed sedation using a midazolam/narcotic combination for EUS proved inferior to sedation using propofol given by an anesthesiologist. Specifically, a midazolam/narcotic combination provided less effective intraprocedural conditions, was less efficient both before and after the procedure, and was less satisfactory to patients as compared with propofol. Results of this type of analysis can be used to drive appropriate system redesign and improve patient care.

Redefining Quality in Endoscopic Sedation

“…The use of propofol was associated with faster induction and recovery of sedation, higher postprocedure patient satisfaction, and quicker return to baseline function. Procedure times and the frequency of adverse events were similar in both groups [4]. As noted previously, propofolbased sedation improved operational efficiency and patient satisfaction compared to traditional methods of sedation.…”

“…Nearly all parameters of the endoscopic examination were superior with propofol compared to midazolam. In a similar study involving EUS, investigators used observational analysis and a validated scale in order to compare sedation quality between anesthesia-assisted propofol and benzodiazepine/opioid combination [4]. Once again, the quality of sedation was adjudged to be superior with propofol with fewer episodes of under-and over-sedation, quicker sedation induction and recovery times, and higher ratings for patient satisfaction.…”

Efficacy of Propofol Sedation for Endoscopic Submucosal Dissection (ESD): Assessment with Prospective Data Collection

“…With the expansion of its indications, furthermore, the significance of stable long-term intraoperative sedation to achieve safe ESD is increasing. Benzodiazepins, especially midazolam, which has a short half-life with a clear on-off of its effect, have long been used as sedatives for endoscopy (7,9,10,12,13). ESD, however, requires a longer procedure time than other endoscopic interventions.…”

“…Recently, an increasing number of papers have been published on the use of propofol (7)(8)(9)(10)(11)(12)(13)(14). Propofol has an immediate onset (30-60 sec) and a half-life of 1.3-4.1 minutes, which is much shorter than those of benzodiazepine and advantageous for introduction and recovery from sedation.…”

Predicting what can go wrong at endoscopic ultrasound: a large series experience

“…In particular, patient discomfort or restlessness (accounting for 31% of all unplanned events in our cohort, especially in Afro-Caribbean patients) could probably be avoided by the use of propofol sedation. Propofol administration has been shown to be superior to other agents with regard to recovery time and physician as well as patient satisfaction 32–34. Previous studies have also demonstrated a high level of safety for propofol monotherapy and combination therapy in gastrointestinal endoscopy 35…”