Sedation in gastrointestinal endoscopy: a prospective study comparing nonanesthesiologist-administered propofol and monitored anesthesia care

Abstract

Introduction: Adequate sedation is one of the cornerstones of good quality gastrointestinal endoscopy (GIE). Propofol sedation has increased significantly but there has been much debate over whether it can be administered by endoscopists. The aim of this prospective trial was to compare nonanesthesiologist-administered propofol (NAAP) and monitored anesthesia care (MAC). Methods: A total of 2000 outpatients undergoing GIE at Hospital Albert Einstein (São Paulo, Brazil), a tertiary-care private hospital, were divided into two matched groups: NAAP (n = 1000) and MAC (n = 1000). In NAAP, propofol doses were determined by the endoscopist. A second physician stayed in the room during the entire procedure, according to local regulations. In MAC, the anesthesiologist administered propofol. Results: In total, 1427 patients (71.3 %) were ASA (American Society of Anesthesiologists) class I and 573 were ASA class II. In NAAP, patients received more propofol + fentanyl (61.1 % vs. 50.5 %; P < 0.05) and there were fewer cases of deep sedation (44.7 % vs. 66.1 %; P < 0.05). Hypoxemia rates were similar (12.8 % for NAAP and 11.2 % for MAC; P = 0.3) but these reverted more rapidly in MAC (4.22 seconds vs. 7.26 seconds; P < 0.05). Agitation was more frequent in MAC (14.0 % vs. 5.6 %; P < 0.05). No later complications were observed. Patient satisfaction was very high and similar in both groups. Conclusion: In this setting, NAAP was as safe and effective as MAC for healthy patients undergoing GIE.Clinical trial ref. no.: U1111-1134-4430

A comparison of propofol and midazolam/meperidine sedation in upper gastrointestinal endoscopy.

“…To calculate the sample size for this study, the incidence of adverse cardiopulmonary events including hypotension and hypoxemia was assumed to be approximately 34% for propofol sedation, as was found in a previous study [17]. Power analysis with α = 0.05 and β = 0.2 to determine a 50% reduction in adverse cardiopulmonary events with meperidine and midazolam revealed that each group required a minimum of 36 patients.…”

High-flow nasal cannula versus standard oxygen therapy assisting sedation during endoscopic retrograde cholangiopancreatography in high risk cases (OTHER): study protocol of a randomised multicentric trial

“…5 Flinders Medical Centre, Bedford Park, South Australia, Australia. 6 Department of Anaesthesia, The Queen Elizabeth Hospital, Woodville, South Australia, Australia. 7 Human Physiology Anaesthesia and Intensive Care, School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia.…”

“…Reasons for desaturation during ERCP under deep sedation have been attributed to reduced cardiopulmonary reserve, advanced age, respiratory depression, duration of the procedure, and prone positioning. The incidence of hypoxemia during any endoscopic procedure is in the range of 11%-50% [5][6][7] and it is possibly as high as 60% with ERCP [8] (definitions of hypoxia vary between the studies). Prolonged hypoxia is a major risk factor for periprocedural cardiac arrhythmias and myocardial ischaemia [9][10][11].…”

LMA® Gastro™ Airway for endoscopic retrograde cholangiopancreatography: a retrospective observational analysis

“…Moderate to deep sedation is a commonly employed technique for ERCPs, with general anaesthesia utilising an endotracheal intubation being reserved for selected cases. Reported rates of hypoxemia during all endoscopic procedures range from 11 to 50% [1][2][3], and this may be as high as 60% with ERCP [4]. (Definitions of hypoxia vary between the studies.)…”