European Society of Gastrointestinal Endoscopy, European Society of Gastroenterology and Endoscopy Nurses and Associates, and the European Society of Anaesthesiology Guideline: Non-anesthesiologist administration of propofol for GI endoscopy

Abstract

Propofol sedation by non-anesthesiologists is an upcoming sedation regimen in several countries throughout Europe. Numerous studies have shown the efficacy and safety of this sedation regimen in gastrointestinal endoscopy. Nevertheless, this issue remains highly controversial. The aim of this evidence- and consensus-based set of guideline is to provide non-anesthesiologists with a comprehensive framework for propofol sedation during digestive endoscopy. This guideline results from a collaborative effort from representatives of the European Society of Gastrointestinal Endoscopy (ESGE), the European Society of Gastroenterology and Endoscopy Nurses and Associates (ESGENA) and the European Society of Anaesthesiology (ESA). These three societies have endorsed the present guideline

Flexible bronchoscopy under conscious sedation with midazolam and fentanyl can be safely performed by nonanesthesiologists

“…9 These drugs proved to be safe in several studies used by nonanesthesiologists, [5][6][7] and are recommended by most gastroenterology and respiratory societies to use for moderate sedation in various endoscopic procedures. 4,10,11 Despite this, anesthesiology societies have raised several safety concerns, especially regarding the use of propofol 12 by nonanesthesiologists, and the use of moderate sedation has not been legally approved in many countries (including Poland), being restricted solely to anesthesiologists. One of the main concerns of is the anesthesiologists concept of the continuum of sedation, which means that the patient's sedation status can change anytime during anesthesia and advance to deeper anesthesia, which requires mechanical ventilation support.…”

Post-Anaesthetic Discharge Scoring System to assess patient recovery and discharge after colonoscopy

“…Efforts to shorten recovery time by using sedative agents with shorter half life are gaining increasing popularity. The European Guidelines concerning NonAnaesthesiologist Administered Propofol (NAAP) for Gastrointestinal Endoscopy was published in 2010 [16] , but 21 national societies of anaesthesiology in Europe signed a Consensus Statement to declare their disagreement with the NAAP guidelines [17] . Moreover, because of the well-known risks of Propofol administration, the manufacturers of the drug have added the following restriction: "For general anesthesia or monitored anesthesia care (MAC) sedation, DIPRIVAN Injectable Emulsion should be administered only by persons trained in the administration of general anesthesia and not involved in the conduct of the surgical/diagnostic procedure".…”

Propofol to Increase Colorectal Cancer Screening in Portugal

“…This modality is currently endorsed by several societal guidelines, including the four major American societies (AGA, ACG, ASGE and AASLD), the European Society of Gastrointestinal Endoscopy (ESGE) and, however briefly, the European Society of Anaesthesiolgy. 4 In fact, for the sedation of low risk patients, the cost-effectiveness of having an anesthetist is not satisfactory, being calculated by Rex et al to be in the range of $ 5.3 million/life year in a study with a mortality rate of 1:161515 cases 3 which does not exceed published mortality rates for general anesthesia which is 1:13322 (overall) and 1:200200 in ASA I-II. 5 Propofol sedation has been gaining momentum in the last decade in several European countries (Germany, Switzerland, Austria, Denmark) but despite the existing evidence and the endorsement by scientific societies, propofol is still underused in most countries.…”