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

Abstract

Background Endoscopist-directed balanced propofol sedation (BPS) appears to be safe and effective for routine endoscopy. However, there are limited data on its use in endoscopic retrograde cholangiopancreatography (ERCP). We evaluated the safety and efficacy of endoscopist-directed BPS for ERCP, and compared patient outcomes with anesthesiologist-administered moderate sedation. Methods This was a retrospective cohort study, using prospectively collected endoscopy data from a tertiary care medical center where endoscopist-directed BPS during ERCP is routine practice. Adverse outcomes included need for bag-mask ventilation or intubation, aborted ERCP due to sedation, hospital admission post-ERCP (outpatients)/change in the level of care (inpatients), and death within 24 h. Results A total of 501 patients underwent ERCP with the use of endoscopist-directed BPS: Cohort 1-380 (76%) inpatients, mean age 64.1, 46% male, 24% American Society of Anesthesiologists physical status (ASA) score I, 65% ASA II, 11% ASA III. Concurrently, 24 patients received anesthesiologist-administered moderate sedation: Cohort 2-19 (79%) inpatients, mean age 65.0, 67% male, 12% ASA I, 25% ASA II, 38% ASA III, 25% ASA IV. In Cohort 1, none of the adverse outcomes were observed. Propofol dose was inversely correlated with age (r=-0.42, P<0.001), ASA score (r=-0.19, P<0.001), and Mallampati score (r=-0.24, P<0.001). One patient in Cohort 2 who received anesthesiologist-administered BPS required bag-mask ventilation and the ERCP was prematurely aborted because of the sedation. There were no deaths from any cause within 24 h of ERCP. Conclusion Endoscopist-directed BPS appears safe, efficacious, and feasible for ASA I-III patients undergoing inpatient or ambulatory ERCP.

Sedation-related complications during anesthesiologist-administered sedation for endoscopic retrograde cholangiopancreatography: a prospective study

“…The mortality rate was 1%; however, these patients died of non-sedation related events secondary to underlying disease. Lapidus et al reported high safety and efficacy of endoscopist-administered balanced propofol sedation during ERCP without any adverse outcomes [23]. However, patients included in their study were classified as ASA classes I and II (indicating inclusion of a large percentage of low-risk patients).…”

Safety Profile of Endoscopist-directed Balanced Propofol Sedation for Procedural Sedation

“…Many countries, other than United States, continue to use nurse-administered propofol sedation for endoscopic procedures both as monotherapy [28][29][30] and as BPS. [31][32][33] McKenzie et al 34 from Utah recently published their data on EDBPS from 2015 to 2018, demonstrating the safety of EDBPS. AEs occurred in 334 (17.6%) patients, all of which were transient and easily treated.…”

Moderate and deep sedation for non-invasive paediatric procedures in tertiary maternity and children’s hospitals in China: A questionnaire survey from China

“…Our study reveals that other sedation providers such as nurses and radiologists are also involved. Many studies have reported that sedation can be performed safely by endoscopists [16][17] , radiologists 18 , and nurses 19 or even controlled by patients themselves 18,20 . Although it seems that many different types of providers can perform sedation, the individual must be competent in lifesupport skills.…”