Sedation during endoscopic retrograde cholangiopancreatography: a randomized controlled study of patient-controlled propofol sedation and that given by a nurse anesthetist

Nilsson, Andreas; Grossmann, Benjamin; Kullman, Eric; Uustal, Eva; Sjöberg, Folke; Nilsson, Lena

doi:10.3109/00365521.2015.1038848

Cited by 17 publications

(39 citation statements)

References 19 publications

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“…The rate of adverse effects of ERCP (9, 10) and sedation (11, 12) in this study was similar to other studies on the subject. This would lend credence to the notion that the results of this study should be applicable outside the Endoscopy Unit, in which this study was conducted.…”

Section: Discussionsupporting

confidence: 90%

Effect And Predictive Value Of Routine Preoperative Laboratory Testing For Endoscopic Retrograde Cholangiopancreatography

et al. 2019

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Background and Aims: Several studies and guidelines are questioning routine preoperative laboratory tests in surgical and endoscopic procedures. Their effect in endoscopic retrograde cholangiopancreatography is not currently known. This study was carried out to evaluate the risk of adverse effects in endoscopic retrograde cholangiopancreatography and their association with preoperative lab tests. Materials and Methods: A single-center, prospective observational study on all 956 patients undergoing 1196 endoscopic retrograde cholangiopancreatographies in the Endoscopy Unit of Helsinki University Central Hospital from 1 March 2012 to 28 February 2013. Routine preoperative laboratory test results (basic blood count, creatinine, potassium, sodium, international normalized ratio/thromboplastin time, and amylase), health status, medication, and demographic information of all patients were analyzed in relation to adverse effects related to endoscopic retrograde cholangiopancreatography and procedural sedation. Results: Multivariate analysis showed post–endoscopic retrograde cholangiopancreatography pancreatitis (43 cases, 3.6%) to have no association with abnormal routine preoperative laboratory tests. Respiratory depression caused by sedation (128 cases, 11%) was not associated with abnormal routine preoperative laboratory tests, and anemia was found to be a slightly protecting factor. Cardiovascular depression caused by sedation was associated with thrombocytopenia (odds ratio = 1.87, p = 0.025) and, in male patients, hyponatremia (odds ratio = 3.66, p < 0.001). Incidence of other adverse effects was too low for statistical analysis. Conclusion: Routine universal preoperative lab testing was not found to be successful in predicting adverse effects in endoscopic retrograde cholangiopancreatography procedures. Laboratory testing should be done focusing on each patient’s individual needs.

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Section: Discussionsupporting

confidence: 90%

Effect And Predictive Value Of Routine Preoperative Laboratory Testing For Endoscopic Retrograde Cholangiopancreatography

et al. 2019

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“…Therefore, PCS is a cost-saving method for sedation during endoscopic procedures that can also improve procedure feasibility and patient satisfaction without affecting patient safety. 14,15 All procedures under PCS might not be possible to continue and require full anaesthesia to complete. With a bedside anaesthetic nurse and an anaesthesiologist immediately available, this can be accomplished.…”

Section: Discussionmentioning

confidence: 99%

“…The economic data from two sedation studies conducted at Linköping University Hospital in Sweden were analysed retrospectively. The first study evaluated ERCP 14 and was conducted at the Surgical Clinic between January 2011 and May 2012. The second study examined bronchoscopy 15 and was conducted at the Department of Pulmonary Medicine between April 2016 and May 2017.…”

Section: Me Thodsmentioning

confidence: 99%

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Patient‐controlled sedation with propofol for endoscopic procedures—A cost analysis

Grossmann

Nilsson

Sjöberg

et al. 2019

Acta Anaesthesiol Scand

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Background: Patient-controlled sedation (PCS) with propofol accompanied by a bedside nurse anaesthetist is an alternative sedation method for endoscopic procedures compared with midazolam administered by a nurse or endoscopist. Increasing costs in health care demands an economic perspective when introducing alternative methods. We applied a hospital perspective on a cost analysis comparing different methods of sedation and the resource use that were expected to affect cost differences related to the sedation.Methods: Based on two randomised previous studies, the direct costs were determined for different sedation methods during two advanced endoscopic procedures: endoscopic retrograde cholangiopancreatography (ERCP) and flexible bronchoscopy including endobronchial ultrasound. ERCP comparisons were made between midazolam sedation by the endoscopic team, PCS with a bedside nurse anaesthetist and propofol sedation administered by a nurse anaesthetist. Bronchoscopy comparisons were made between midazolam sedation by the endoscopic team and PCS with a bedside nurse anaesthetist, categorised by premedication morphine-scopolamine or glycopyrronium.Results: Propofol PCS with a bedside nurse anaesthetist resulted in lower costs per patient for sedation for both ERCP (233 USD) and bronchoscopy (premedication morphine-scopolamine 267 USD, premedication glycopyrronium 269 USD) compared with midazolam (ERCP 425 USD, bronchoscopy 337 USD). Aborted procedures that needed to be repeated and prolonged hospital stays significantly increased the cost for the midazolam groups. Conclusion:Propofol PCS with a bedside nurse anaesthetist reduces the direct sedation costs for ERCP and bronchoscopy procedures compared with midazolam sedation.

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“…Instead, we added 5 minutes for the start/preparation respectively completion/dismantling of the procedure (10 minutes in total) to the measured procedural time. Our main finding that PCS is a cost-saving method was primarily based on reduced costs for hospital stay and avoidance of aborted procedures that had to be The patients in both studies 3,4 had adequate and sufficient sedation upon insertion of endoscope and during the procedure. The post-procedural assessment by the patients using PCS in both studies showed significantly higher satisfaction of the procedure compared with patients administrated midazolam.…”

Section: Response Letter To the Editormentioning

confidence: 97%

Response Letter to the editor

Grossmann

Nilsson

Sjöberg

et al. 2020

Acta Anaesthesiol Scand

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Sedation during endoscopic retrograde cholangiopancreatography: a randomized controlled study of patient-controlled propofol sedation and that given by a nurse anesthetist

Abstract: PCS with propofol is superior to midazolam and comparable to ACS. PCS resulted in a rapid recovery, fewer respiratory events, and was almost as effective as ACS in ensuring a successful examination.

Cited by 17 publications

References 19 publications

Effect And Predictive Value Of Routine Preoperative Laboratory Testing For Endoscopic Retrograde Cholangiopancreatography

Effect And Predictive Value Of Routine Preoperative Laboratory Testing For Endoscopic Retrograde Cholangiopancreatography

Patient‐controlled sedation with propofol for endoscopic procedures—A cost analysis

Response Letter to the editor

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