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

Safety and efficacy of endoscopist-directed balanced propofol sedation during endoscopic retrograde cholangiopancreatography

“…It appears that our data, although not very comprehensive by general standards, do shed significant light on the specific context of the more challenging clinical setting of ERCP [15,52]. When combined with additional recent publications, they contribute to a growing evidence base of retrospective data showing the safety of endoscopic-directed BPS over the gamut of endoscopic procedures in low-, moderate-and high-risk patients (ASA I-III) [12].…”

“…Of these studies, the largest single study reported on 156 patients who received endoscopistdirected propofol sedation [40]. It is logical to assume that the key to relieving the financial burden of using propofol as part of a moderate sedation regimen is through demonstration of its safety and efficacy when given by the endoscopist [14,15]. In fact, this has already been shown to be the case in routine colonoscopy and esophagogastroduodenoscopy procedures, according to several reports [7][8][9][10][11].…”

“…In the framework of NAAP, balanced propofol sedation (BPS), defined as incremental doses of propofol in combination with fixed doses of an opioid (e.g., fentanyl) and a benzodiazepine (e.g., midazolam) [5], has gained acceptance as a useful and safe means of providing moderate sedation in GI endoscopic procedures [6][7][8][9][10][11][12]. This includes the use of BPS in advanced GI endoscopy procedures (e.g., ERCP) [13][14][15][16][17], where, compared to traditional moderate sedation, it has been found to be safe and beneficial in terms of shorter procedure and recovery times, high patient satisfaction, and similar rates of adverse events [3,13,18].…”

Substantial Increase in Anesthesia Assistance for Outpatient Colonoscopy and Associated Cost Nationwide

“…However, nonanesthesiologist administered propofol sedation is an uncommon but existing option in some settings with limited access to anesthesiology resources. 25,26 The Perspective database predominantly contains patients treated at small to midsize hospitals throughout the United States, whereas many outpatient colonoscopies are additionally performed at larger hospitals and ambulatory surgical centers. As such, our results may not be generalizable to the entire U.S. population.…”

Anesthesia on the run

“…These standards do not seem to be shared by the professional groups who support NAAP and perhaps -in addition to the issue of lack of airway rescue skills -is another reason why neither the American Society of Anesthesiologists (ASA) nor the European Society of Anesthesiologists endorses the concept [8]. For example, in 2010, the ASA mandated the use of end-tidal carbon dioxide monitoring in all cases involving the administration of moderate and deep sedation [9].…”