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

Abstract

Background: Nurse-administered propofol sedation was restricted to anesthesiologists in 2009, a practice that has contributed to spiraling health care costs in the United States. Aim:The aim of this study was to evaluate the safety of endoscopistdirected balanced propofol sedation (EDBPS). Materials and Methods:We identified patients undergoing endoscopy with EDBPS from January 1, 2017, to June 20, 2017, and abstracted their medical records. Adverse events (AEs) included: hypoxia (oxygen saturation < 90%); hypotension [(a) systolic blood pressure < 90 mm Hg, (b) systolic blood pressure decline of > 50 mm Hg, (c) decline in mean arterial pressure of > 30%]; bradycardia (heart rate of < 40 beats/min). Logistic regression identified factors independently associated with AEs.Results: A total of 1897 patients received EDBPS during the study period [mean age: 55 y (SD = 11.4 y); 56.4% women]. Patients received median doses of 50 µg fentanyl, 2 mg of midazolam, and a mean propofol dose of 160 ± 99 mg. There were no major complications (upper 95% confidence interval, 0.19%). Overall, 334 patients (17.6%) experienced a clinically insignificant AE: 65 (3.4%) experienced transient hypoxia, 277 patients (14.6%) experienced hypotension, 2 had transient bradycardia. In bivariate analysis, older age was associated with risk for hypotension, propofol dose was associated with transient hypoxemia, and procedure duration was associated with both hypotension and transient hypoxia. In multivariate analysis, only procedure length was associated with AEs (odds ratio scale 10; odds ratio = 1.07; 95% confidence interval, 1.05-1.09, P < 0.001).Conclusions: EDBPS is safe for endoscopic sedation. Given the higher cost of anesthesia-administered propofol, endoscopists should reinstate EDBPS by revising institutional sedation policies.

Prevention of peri-interventional hypothermia during endoscopic retrograde cholangiopancreatography using a forced-air heating system

“…Today, most gastrointestinal endoscopies are performed under moderate sedation. Numerous studies from Europe and North America have shown that nurse-administered propofol sedation (NAPS) is feasible and safe, provided it is performed in appropriately selected patients and endoscopies 16 17 18 19 . In Germany, uncomplicated endoscopic examinations have been carried out by properly trained non-anesthesia staff in outpatient and inpatient settings for years and this is supported by the sedation guideline from the German Society for Gastroenterology and Digestive and Metabolic Diseases (DGVS) 12 .…”

Efficacy and safety of remimazolam tosylate for sedation during upper gastrointestinal endoscopy: study protocol for a multicenter randomized controlled trial

“…Compared with propofol, remimazolam has no injection pain and has a lower incidence of hypotension [ 14 ]. In the USA, only anesthesiologists are authorized to administer propofol [ 15 ]. However, unlike propofol, remimazolam belongs to benzodiazepine, which allows it to be used without specific restrictions.…”