Nonanesthesiologist-administered propofol sedation: from the exception to standard practice. Sedation and monitoring trends over 20 years

Abstract

The practice of sedation, including monitoring practice for digestive endoscopy, continues to evolve throughout the world. In many countries, including Switzerland, there is a trend towards increased utilization of sedation during both routine and advanced endoscopic procedures. Sedation improves patient satisfaction with endoscopy and also improves the quality of the examination. In addition, a trend can be observed towards an increasing use of propofol as the preferred sedative drug. Here we review the latest published data from surveys describing sedation and monitoring practice in different countries and compare them with our own data from successive nationwide surveys among Swiss gastroenterologists over a period of 20 years. This development between these socioeconomically very similar Western industrialized countries, however, shows some unique and surprising differences. In Germany and Switzerland, propofol use has become increasingly widespread, in Switzerland even to the extent that during the last few years propofol has overtaken benzodiazepine sedation, with an absolute majority of Swiss gastroenterologists using it without the assistance of an anesthesiologist. In addition, the change in Switzerland reflects a successful generalization of nonanesthesiologist-administered propofol (NAAP) sedation from the hospital setting to private practice.

Factors affecting successful colonoscopy procedures: Single-center experience

“…The most frequent pathology following normal findings is haemorrhoidal dis-ease. Haemorrhoidal disease rates are seen to be around 14%-58% in our country (4,5,18). Different rates in the literature were obtained from different geographic regions, and 21% rate in our study supports the haemorrhoidal disease rate in Istanbul region.…”

“…Unfortunately, the fact that Anesthesia and Reanimation Specialists are inadequate in number for colonoscopy examinations, reduces the success rates. Administration of propofol by nurses has shown better results but it's not possible for regulations in our country (18). Overcoming the obstacle of inadequate bowel cleansing is possible and additional bowel cleansing preparation was made for repeating in our patients the following day.…”

Risk Factor for Vital Signs Fluctuation during Colonoscopy under Conscious Sedation Consisting of Midazolam and Meperidine

“…Propofol is becoming more commonly used as a sedative during CS, especially in western countries, due to its rapid introduction and recovery as well as high patient satisfaction [7,10,11,[19][20][21] ; however, it may cause severe cardiopulmonary suppression. Therefore, the attendance of an anesthesiologist or the use of dedicated infusion devices (such as a target controlled infuser or computer-assisted personal sedation pump) has been recommended for certain subjects [7-11, 17, 21].…”

Myths, fallacies and practical pearls in GI lab

“…This myth is quite prevalent in the United States and some other parts of the world, whereas in many other places, including Switzerland, increasing adoption of Propofol by the gastroenterologist has been reported [27] . On this issue, extensive data is available, spanning more than a decade.…”