Propofol sedation during endoscopic procedures: how much staff and monitoring are necessary?
BACKGROUND
Propofol has been shown to be safe for nonanesthetist use during GI endoscopy. However, published studies involved propofol administration by an additional nurse or used specialized patient monitoring or were carried out in tertiary hospitals.


OBJECTIVE
Considering the downward pressure on reimbursement for endoscopic procedures, we asked how much staff and monitoring is necessary for safe use of propofol.


METHODS
Two private gastroenterology practices.


METHODS
A total of 27,061 endoscopic procedures (14,856 EGDs and 12,205 colonoscopies) were prospectively assessed regarding patient characteristics, American Society of Anesthesiologists (ASA) status, dosage of propofol, fall of oxygen saturation below 90%, need to increase nasal oxygen administration above 2 L/min, and need for assisted ventilation.


METHODS
Propofol was administered by the endoscopy nurse supervised by the endoscopist. Patient monitoring consisted of only pulse oximetry and clinical assessment.


RESULTS
The mean propofol dose for EGD was 161 mg (range 50-650 mg). During colonoscopy patients received a mean propofol dose of 116 mg (30-500 mg) in addition to 25 mg of meperidine. Oxygen saturation fell below 90% (lowest 74%) in 623 procedures (2.3%), normalizing within less than 30 seconds by stimulating the patient and increasing the nasal oxygen flow to 4 to 10 L/min. Six patients (ASA III) required mask ventilation for less than 30 seconds. No endotracheal intubation was necessary.


CONCLUSIONS
There was no further follow-up regarding adverse events after patient discharge from the endoscopy unit.


CONCLUSIONS
An endoscopy team, consisting of 1 physician endoscopist and 1 endoscopy nurse, can safely administer propofol sedation for GI endoscopy in a practice setting without additional staff or specialized monitoring.
Külling
Daniel
D
Praxis für Gastroenterologie und Endoskopie, Zürich, Switzerland.
Orlandi
Marcello
M
Inauen
Werner
W
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003113:Colonoscopy / Q000191:economics; D016292:Procedural Sedation / Q000191:economics* / Q000451:nursing; D017046:Cost Savings; D016145:Endoscopy, Digestive System / Q000191:economics; D016099:Endoscopy, Gastrointestinal / Q000191:economics* / Q000451:nursing; D005260:Female; D006301:Health Services Needs and Demand / Q000191:economics; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000191:economics* / Q000451:nursing; D009719:Nurse Anesthetists / Q000191:economics; D010092:Oximetry / Q000191:economics; D010348:Patient Care Team / Q000191:economics; D015742:Propofol; D011446:Prospective Studies; D013557:Switzerland
D015742:Propofol