Nurse-administered propofol sedation for upper endoscopic ultrasonography.
BACKGROUND
Limited data exist regarding the safety of nurse-administered propofol sedation (NAPS) for advanced endoscopy.


OBJECTIVE
To evaluate the frequency of and the risk factors for complications associated with NAPS for upper endoscopic ultrasound (EUS).


METHODS
Consecutive upper EUS examinations using NAPS were retrospectively identified. Clinical data and adverse events were recorded. Univariate and multivariable repeated measures logistic regression models were used to identify independent risk factors for complications.


RESULTS
Among 806 EUS procedures, the mean procedure duration, time for sedation induction, and postprocedure recovery time were: 34 +/- 20 min, 3.6 +/- 1.4 min, and 27 +/- 23 min, respectively. A decline in systolic blood pressure (SBP) to <90 mm Hg occurred in 104 patients (13%). Six patients (0.7%) had a decline in oxygen saturation (SpO(2)) to <90%. Four patients (0.5%; 95% confidence interval [CI] 0.14-1.27) required assisted positive pressure ventilation. There were no major complications. The minor complication rate from sedation was 21% (95% CI 17.2-25.3). All of the complications were clinically insignificant. Overall complication risk was not related to age, dose, or procedure time. Sedation-related complication rates for advanced experience-level (> or =100 NAPS procedures) nurses were lower compared to the least-experienced (< or =30 NAPS procedures) nurses (17.2%vs 25.4%, odds ratio [OR] 0.61, 95% CI 0.41-0.92).


CONCLUSIONS
NAPS for upper EUS is safe and may be performed without major complications. Four patients (0.5%) required assisted ventilation. Minor complications occurred in 21% of patients, but were not associated with patient age, propofol dose, or procedure time.
Division of Gastroenterology, Department of Medicine, Indiana University Medical Center, Indianapolis, Indiana 46202-5121, USA.
Hala
H
Fatima
John
J
DeWitt
Julia
J
LeBlanc
Stuart
S
Sherman
Kathleen
K
McGreevy
Thomas F
TF
Imperiale
D001794:Blood Pressure; D016292:Procedural Sedation / Q000009:adverse effects / Q000451:nursing*; D016099:Endoscopy, Gastrointestinal; D019160:Endosonography / Q000379:methods*; D005260:Female; D041981:Gastrointestinal Tract / Q000000981:diagnostic imaging*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D011175:Positive-Pressure Respiration; D015742:Propofol / Q000008:administration & dosage*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors
D006993:Hypnotics and Sedatives; D015742:Propofol