Gastroenterologist-administered propofol for therapeutic upper endoscopy with graphic assessment of respiratory activity: a case series.
BACKGROUND
Traditional methods of sedation and analgesia for advanced endoscopic procedures can be inadequate and frequently prolong recovery room observation. Propofol is a rapidly acting agent that produces an excellent hypnotic state, but its use is typically limited to anesthesiologist-assisted cases because of the inadequacy of current monitoring standards to reliably detect early stages of respiratory depression.


METHODS
Ten patients undergoing advanced upper endoscopic procedures (endoscopic retrograde cholangiopancreatography, endoscopic ultrasound, esophageal stent placement) received a propofol infusion under the control of a second qualified gastroenterologist with advanced cardiac life support skills. Graphic assessment of respiratory activity was made by using a sidestream carbon dioxide detecting cannula. Patient satisfaction was measured with a 100 mm visual analog scale. Recovery scores were measured by standardized scoring of discharge criteria.


RESULTS
Monitoring with graphic assessment of respiratory activity detected early phases of respiratory depression, resulting in a timely decrease in the propofol infusion without significant hypoxemia, hypercapnia, hypotension, or arrhythmias. Satisfaction scores were extremely high (median score 92 of 100) and 9 of 10 patients met discharge criteria at 15 minutes after discontinuation of the propofol infusion.


CONCLUSIONS
With the use of monitoring by graphic assessment of respiratory activity, propofol infusion by a second qualified gastroenterologist for prolonged upper endoscopic procedures is safe and results in high levels of patient satisfaction with rapid recovery times.
Center for Pancreaticobiliary Diseases, Department of Gastroenterology, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
J J
JJ
Vargo
G
G
Zuccaro
J A
JA
Dumot
S S
SS
Shay
D L
DL
Conwell
J B
JB
Morrow
D000328:Adult; D000368:Aged; D001143:Arousal; D016022:Case-Control Studies; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods; D016292:Procedural Sedation; D004066:Digestive System Diseases / Q000175:diagnosis / Q000628:therapy; D004562:Electrocardiography; D016145:Endoscopy, Digestive System / Q000379:methods*; D019160:Endosonography / Q000379:methods; D005260:Female; D005762:Gastroenterology / Q000379:methods; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D015742:Propofol / Q000008:administration & dosage*; D012119:Respiration / Q000187:drug effects; D012680:Sensitivity and Specificity
D006993:Hypnotics and Sedatives; D015742:Propofol