Sedation with propofol controlled by endoscopists during percutaneous endoscopic gastrostomy

Abstract

Background: propofol is a hypnotic used with increasing frequency for sedation during endoscopic procedures. Most of the reports published related with its employment by non-anaesthesiologists, refers to basic endoscopy, with little reference to its use in advanced endoscopy.Objective: to evaluate the efficacy and safety of propofol sedation administered by endoscopists, while performing percutaneous endoscopic gastrostomy, an advanced technique that is usually performed in high anesthetic level risk patients.Material and methods: prospective study of a series of endoscopic gastrostomy performed consecutively in our department; the sedation was carried out exclusively with propofol. The staff in the room consisted of two medical gastroenterologists, a nurse and a nursing assistant. Propofol was administered by bolus doses adjusted to patient weight. Arterial oxygen saturation, heart rate and blood pressure were monitored; respiratory activity was monitored visually by observing respiratory excursions of the patient.Results: we included 47 patients, with an average age of 82 years. 87% were ASA III and the rest, ASA IV. The mean dose of propofol was 51 mgr. Complications were recorded: 8 cases of desaturation and two of hypotension, all of them minor and quickly reversible. All procedures were carried out successfully, at a median time of 8 minutes.Conclusion: the propofol sedation carried out by non-anaesthesiologist trained staff, seems to appear as a safe and effective procedure while performing percutaneous endoscopic gastrostomy.

Clinical analysis of moderate-to-deep-sedation by nonmedical sedation practitioners in 597 patients undergoing gastrointestinal endoscopy: a retrospective study

“…Quality and safety usually have not been primary considerations in the development of these solutions, which rapidly became popular because of their ease of application. A number of articles have discussed the use of propofol by clinicians 19 20 , mostly gastroenterologists, who have no training in anesthesia or resuscitation. In contrast, anesthesiologists, in particular in the United States, abide by the official Food and Drug Administration (FDA) standpoint that propofol should be administered only by persons trained in general anesthesia 21 .…”

Seguridad y eficiencia de sedación balanceada con propofol y remifentanil en endoscopia digestiva alta diagnóstica. Una experiencia exitosa

“…Otros autores han concluido que la sedación tradicional con benzodiacepinas y opiáceos obtiene un índice menor de mortalidad que cuando se usa propofol, y un índice similar al que se presenta en anestesia general realizada por anestesiólogos (17). También concluyen que la sedación administrada por no anestesiólogos puede incluso tener mayores niveles de seguridad en pacientes de ASA >III, siempre y cuando se dediquen en forma única y exclusiva a administrar y controlar la sedación (25)(26)(27).…”

Nurse-Administered Propofol Sedation Training Curricula and Propofol Administration in Digestive Endoscopy Procedures

“…Frequently, sedation is managed either by a certified registered nurse anesthetist (CRNA) (Coté et al, 2010) or an adequately trained endoscopy nurse (García-Suárez et al, 2010). In the last 20 years, costs deriving from the presence of an anesthesiologist (Dumonceau, 2012) administrating propofol were particularly high compared with a nonanesthesiologist (nonanesthesiologist administration of propofol—NAAP) or nurse (nurse-administered propofol sedation—NAPS) (Rex, Heuss, Walker, & Qi, 2005; Vaessen & Knape, 2016).…”