Trained registered nurses/endoscopy teams can administer propofol safely for endoscopy.
OBJECTIVE
Propofol has advantages as a sedative for endoscopic procedures. Its administration by anesthesia specialists is associated with high cost. Administration by nonanesthesiologists is controversial because of concerns about safety, particularly respiratory depression.


METHODS
Three endoscopy units developed programs to train registered nurses supervised only by endoscopists in the administration of propofol for endoscopic procedures. The rate of adverse respiratory events was tracked from the inception of the programs. To estimate whether training nurses to give propofol on a widespread basis might be effective, we evaluated the individual safety records of all nurses and endoscopists involved in propofol delivery at the 3 centers.


RESULTS
Among a total of 36,743 cases of nurse-administered propofol sedation (NAPS) at the 3 centers, there were no cases requiring endotracheal intubation or resulting in death, neurologic sequelae, or other permanent injury. The rate of respiratory events requiring assisted ventilation was not significantly different among the 3 centers and ranged from just <1 per 500 cases to just <1 per 1000 cases among the 3 centers. There was no individual nurse or physician for whom the rate of respiratory events requiring assisted ventilation differed from the overall rate of events at the respective centers.


CONCLUSIONS
Trained nurses and endoscopists can administer propofol safely for endoscopic procedures. Nurse-administered propofol sedation is one potential solution to the high cost associated with anesthetist-delivered sedation for endoscopy.
Rex
Douglas K
DK
Division of Gastroenterology/Hepatology, Department of Medicine, Indiana University Hospital, Indianapolis, Indiana 46202, USA. drex@iupui.edu
Heuss
Ludwig T
LT
Walker
John A
JA
Qi
Rong
R
D000758:Anesthesia / Q000451:nursing* / Q000706:statistics & numerical data; D016145:Endoscopy, Digestive System / Q000451:nursing* / Q000706:statistics & numerical data; D005763:Gastroenterostomy / Q000451:nursing; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage* / Q000009:adverse effects*; D010348:Patient Care Team; D015742:Propofol / Q000008:administration & dosage* / Q000009:adverse effects*; D013041:Specialties, Nursing
D006993:Hypnotics and Sedatives; D015742:Propofol