title: Low-dose propofol sedation for diagnostic esophagogastroduodenoscopy: results in 10,662 adults.
abstract: OBJECTIVE
  The use of propofol sedation during endoscopic procedures has increased in recent years. The aim of this study was to evaluate the safety and effectiveness of nurse-administered low-dose propofol sedation for diagnostic esophagogastroduodenoscopy (EGD).
  
  
  METHODS
  We prospectively assessed the outcome and complications of low-dose bolus propofol for endoscopic sedation for diagnostic EGD. Propofol was administered by bolus injection, with a standard protocol of 40 mg for patients <70 years old, 30 mg for patients 70-89 years old, and 20 mg for patients 90 years or older. When required for adequate sedation, additional doses were given, to a maximum of 120 mg. The primary outcome measure was respiratory depression, defined as oxygen desaturation (SpO(2) <90%) that continued for more than 20 s. Secondary measures included successful procedures, full recovery within 60 min of the procedure, and complications.
  
  
  RESULTS
  All procedures were successful; 8,431 of 10,662 patients (79.1%) completed diagnostic EGD with a single bolus of propofol. Only 0.26% (28 patients) required transient supplemental oxygen supply; neither mask ventilation nor endotracheal intubation was required. Full recovery occurred in 99.9% of patients 60 min after the procedure. Men and younger patients required significantly higher doses of propofol than did the women and older patients (men vs. women, 46.5+/-19 vs. 42.7+/-15 mg, P=0.0008; age 40-49 vs. age 50-59, 51.5+/-16 vs. 46.3+/-13 mg, P<0.0001). Of the 400 patients, 368 (92%) wanted to drive home or to their offices, and all did so without incident. A total of 99% were willing to repeat the same procedure again.
  
  
  CONCLUSIONS
  Low-dose nurse-administered propofol sedation is safe and practical for diagnostic EGD.
authors.affiliation: Department of Gastroenterology, Showa Inan General Hospital, Komagane, Japan. horiuchi.akira@sihp.jp
authors.forename: Akira
authors.initials: A
authors.lastname: Horiuchi
authors.forename: Yoshiko
authors.initials: Y
authors.lastname: Nakayama
authors.forename: Nao
authors.initials: N
authors.lastname: Hidaka
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Ichise
authors.forename: Masashi
authors.initials: M
authors.lastname: Kajiyama
authors.forename: Naoki
authors.initials: N
authors.lastname: Tanaka
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000762:Anesthesia Recovery Period; D018686:Anesthetics, Intravenous / Q000008:administration & dosage*; D015331:Cohort Studies; D016292:Procedural Sedation / Q000379:methods*; D004066:Digestive System Diseases / Q000175:diagnosis; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D064420:Drug-Related Side Effects and Adverse Reactions; D016145:Endoscopy, Digestive System / Q000009:adverse effects / Q000379:methods* / Q000451:nursing*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D009719:Nurse Anesthetists; D010147:Pain Measurement; D017060:Patient Satisfaction; D011336:Probability; D015742:Propofol / Q000008:administration & dosage*; D011446:Prospective Studies; D018570:Risk Assessment; D012737:Sex Factors
chemical_list: D018686:Anesthetics, Intravenous; D015742:Propofol