title: Risk stratification and safe administration of propofol by registered nurses supervised by the gastroenterologist: a prospective observational study of more than 2000 cases.
abstract: BACKGROUND
  Conscious sedation is standard for GI endoscopy. Propofol increasingly is used as an alternative drug to avoid unwanted effects of the commonly used benzodiazepines. Although propofol in the hands of nonanesthesiologists is still controversial, this study characterized the safety profile of propofol administered by nurses under supervision of the gastroenterologist.
  
  
  METHODS
  All patients undergoing any endoscopic procedure between September 2000 and December 2001 in the gastroenterology department of an academic tertiary medical center were eligible for inclusion in this prospective observational study. Sedation was voluntary. Demographic data, type of endoscopic procedure, and clinical features were recorded. A structured personal history led to a 5-class risk stratification based on the criteria of the American Society of Anesthesiologists. A total of 3475 procedures were performed in 2574 patients using propofol administered by registered nurses.
  
  
  RESULTS
  No major complications occurred because of the use of propofol, but overall decreases in the mean values for oxygen saturation (-2%), arterial pressure (-18%), and pulse rate (-10%) were observed. Severe respiratory depression requiring intervention occurred in less than 0.3% of all patients given propofol.
  
  
  CONCLUSIONS
  The administration of propofol by registered nurses, with careful monitoring under the supervision of the gastroenterologist, is safe for conscious sedation during GI endoscopic procedures.
authors.affiliation: Department of Gastroenterology, University Hospital Basel, Switzerland.
authors.forename: Ludwig T
authors.initials: LT
authors.lastname: Heuss
authors.forename: Patrizia
authors.initials: P
authors.lastname: Schnieper
authors.forename: Juergen
authors.initials: J
authors.lastname: Drewe
authors.forename: Eric
authors.initials: E
authors.lastname: Pflimlin
authors.forename: Christoph
authors.initials: C
authors.lastname: Beglinger
mesh_terms: D000368:Aged; D003113:Colonoscopy; D016292:Procedural Sedation; D016099:Endoscopy, Gastrointestinal; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000494:pharmacology*; D008297:Male; D008875:Middle Aged; D024802:Nurse's Role; D015742:Propofol / Q000494:pharmacology*; D011446:Prospective Studies; D018570:Risk Assessment
chemical_list: D006993:Hypnotics and Sedatives; D015742:Propofol