Endoscopist-administered propofol: a retrospective safety study.
BACKGROUND
Propofol is an anesthetic agent that is commonly used for conscious sedation. Propofol has advantages as a sedative agent for endoscopic procedures including rapid onset, short half-life and rapid recovery time. However, concerns exist regarding the potential for respiratory depression, hypotension, perforation due to deep sedation and the need for monitoring by an anesthetist. Propofol has been used under endoscopist supervision at the Stanton Territorial Hospital in Yellowknife, Northwest Territories since 1996 (approximately 7000 cases).


METHODS
A retrospective chart review of endoscopic procedures conducted at the Stanton Territorial Hospital between January 1996 and May 2007 was performed. A random sample of 680 procedures was reviewed from a total of 6396 procedures.


RESULTS
The mean (+/- SD) baseline systolic blood pressure (SBP) was 122.8+/-17.0 mmHg. The mean lowest SBP was 101.7+/-14.5 mmHg. The mean absolute drop in SBP was 21.1+/-16.7 mmHg, with a mean per cent drop of 16.3%+/-11.7%. Eighty-eight patients (12.9%) developed transient hypotension (SBP lower than 90 mmHg). All patients regained normal blood pressure spontaneously on repeated measurement. No patients required intravenous fluid resuscitation. The mean O2 saturation was 96.4%+/-2.1%. One patient (0.1%) transiently desaturated (O2 saturation 89%), but recovered spontaneously on repeat measurement with no intervention. No procedures were aborted for patient safety. There were no major complications, including perforation or death. There was one mucosal tear during nontherapeutic colonoscopy (0.1%).


CONCLUSIONS
Propofol can be safely administered in a community hospital setting under endoscopist supervision, with no additional support or monitoring.
Morse
John W I
JW
Stanton Territorial Hospital, Yellowknife, Canada. john_morse@gov.nt.ca
Fowler
Sharyle A
SA
Morse
Amy L
AL
D000328:Adult; D000368:Aged; D001794:Blood Pressure; D015331:Cohort Studies; D003113:Colonoscopy; D016292:Procedural Sedation; D005260:Female; D005773:Gastroscopy; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D015742:Propofol / Q000008:administration & dosage*; D012189:Retrospective Studies; D018570:Risk Assessment
D006993:Hypnotics and Sedatives; D015742:Propofol