title: Safety of propofol for conscious sedation during endoscopic procedures in high-risk patients-a prospective, controlled study.
abstract: OBJECTIVE
  Propofol, a rapidly-acting hypnotic agent, is increasingly being used for endoscopic sedation. Serious adverse effects, including respiratory and cardiovascular depression, make many endoscopists reluctant to use propofol in critically ill patients. This study characterizes propofol's safety profile in consecutive high-risk patients (American Society of Anesthesiologists [ASA] classes III and IV) compared with matched subjects (ASA classes I and II).
  
  
  METHODS
  During a 19-month period, 1370 at risk-patients were sedated with propofol, of whom 47% (614 ASA III, 28 ASA IV) were age matched with 642 consecutive patients of the same gender and age assigned to ASA classes I and II and undergoing the same endoscopic procedures (395 gastroscopies, 201 colonoscopies, 14 combined). Registered nurses performed all sedations by propofol dose titration while carefully monitoring arterial oxygen saturation, heart rate, and blood pressure.
  
  
  RESULTS
  No major complications occurred among the critically ill patients. There was, however, an increased risk for a short relevant oxygen desaturation (<90%) of 3.6% for ASA III and IV versus 1.7% for ASA I and II (p = 0.036). In four versus one case, short mask ventilation was necessary. Also, a greater proportion of patients showed a > or =5% oxygen saturation decrease. There was no pronounced influence on arterial pressure or heart rate and no perforations in 336 colonoscopies.
  
  
  CONCLUSIONS
  With careful monitoring, propofol sedation during GI endoscopies is safe, even for high-risk patients. Considering their higher comorbidity and tendency toward oxygen desaturation, they need particularly careful monitoring, and the required dose is, on mean, 10-20% lower than in ASA classes I and II.
authors.affiliation: Department of Gastroenterology, University Hospital Basel, 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; D018686:Anesthetics, Intravenous / Q000008:administration & dosage*; D016292:Procedural Sedation / Q000379:methods* / Q000451:nursing; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000451:nursing; D015742:Propofol / Q000008:administration & dosage*; D011446:Prospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome
chemical_list: D018686:Anesthetics, Intravenous; D015742:Propofol