title: Sedation for endoscopy: the safe use of propofol by general practitioner sedationists.
abstract: OBJECTIVE
  To determine the incidence of adverse events related to an endoscopy sedation regimen that included propofol, delivered by general practitioner (GP) sedationists.
  
  
  METHODS
  Audit of reports of sedation-related adverse events in patients undergoing endoscopy. A sample of 1000 patients' medical records was also reviewed to determine the drugs and dosages used and the proportion of sedations delivered by GPs.
  
  
  METHODS
  All patients undergoing gastroscopy and/or colonoscopy from January 1996 to December 2000 in two private endoscopy centres in Canberra. Sedation was provided by GPs or a specialist anaesthetist, in most cases using a drug regimen that included propofol.
  
  
  METHODS
  Incidences of respiratory arrest, airway obstruction, hypoxia requiring intervention, hypotension, and death; number of interventions to correct these events, including extra airway management, bag-mask ventilation, intravenous fluid infusion, endotracheal intubation and the use of reversal agents, and admission to hospital.
  
  
  RESULTS
  28,472 procedures were performed in the five years. There were 185 sedation-related adverse events (6.5/1000 procedures; 95% CI, 5.6-7.4): 107 for airway or ventilation problems (3.8/1000) and 77 hypotensive episodes (2.7/1000). Respiratory-related adverse events were more common in patients managed by GPs than anaesthetists, but this was not significant (P = 0.1). Interventions were recorded in 234 patients (8.2/1000; 95% CI, 7.2-9.3): 123 to maintain ventilation, and 111 intravenous infusions. GPs were more likely than anaesthetists to intervene to manage respiratory-related adverse events (P = 0.03). Four patients required transfer or admission to hospital. No patients required endotracheal intubation, and there were no deaths.
  
  
  CONCLUSIONS
  The GP sedationists encountered a low incidence of adverse events, which they managed effectively. It appears that appropriately selected and trained GPs can safely use propofol for sedation during endoscopy.
authors.affiliation: Mugga Wara & Brindabella Endoscopy Centres, Canberra, ACT. tony-clarke@bigpond.com
authors.forename: Anthony C
authors.initials: AC
authors.lastname: Clarke
authors.forename: Louise
authors.initials: L
authors.lastname: Chiragakis
authors.forename: Lybus C
authors.initials: LC
authors.lastname: Hillman
authors.forename: Graham L
authors.initials: GL
authors.lastname: Kaye
mesh_terms: D019162:Anesthetics, Combined / Q000008:administration & dosage / Q000009:adverse effects; D018686:Anesthetics, Intravenous / Q000008:administration & dosage / Q000009:adverse effects*; D001315:Australia; D003113:Colonoscopy; D005194:Family Practice / Q000592:standards*; D005283:Fentanyl / Q000008:administration & dosage / Q000009:adverse effects; D005773:Gastroscopy; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000009:adverse effects*; D007022:Hypotension / Q000139:chemically induced; D008485:Medical Audit; D008874:Midazolam / Q000008:administration & dosage / Q000009:adverse effects; D015742:Propofol / Q000008:administration & dosage / Q000009:adverse effects*; D012120:Respiration Disorders / Q000139:chemically induced; D012449:Safety
chemical_list: D019162:Anesthetics, Combined; D018686:Anesthetics, Intravenous; D006993:Hypnotics and Sedatives; D008874:Midazolam; D005283:Fentanyl; D015742:Propofol