title: Nurse-administered propofol sedation for endoscopy: a risk analysis during an implementation phase.
abstract: OBJECTIVE
  The aim of the present study was to perform a risk analysis during the implementation phase of nurse-administered propofol sedation (NAPS) and to validate our structured training program.
  
  
  METHODS
  A structured training program was developed both for endoscopists and for endoscopy nurses who were administering propofol sedation. The nurses' program comprised a 6-week course including theoretical and practical training in airway management, and the endoscopists' program consisted of 2.5 h of theory and a short course in practical airway management. In the implementation phase, data from 1822 endoscopic procedures in 1764 patients were prospectively collected. All adverse events related to sedation were recorded (defined as oxygen saturation < 92%, airway handling, assisted ventilation, need for intubation, change in blood pressure > 20 mmHg).
  
  
  RESULTS
  78 cases of hypoxemia were documented in 1764 patients (4.4%), in 56/983 upper endoscopies (5.7%) and 22/754 lower endoscopies (2.9%) (P = 0.007). Assisted ventilation was necessary in 19 cases (1.1%) and anesthesiologic assistance was requested 10 times. Two patients required endotracheal intubation. A change in blood pressure was recorded in 451 patients (26%). Independent risk factors were type of intervention and level of experience of the staff performing the sedation.
  
  
  CONCLUSIONS
  These results were obtained after development of a structured training program both for endoscopists and nurses using propofol for sedation, and can be used as basis for further comparison. NAPS for endoscopic procedures is safe when performed by personnel properly trained in airway handling and sedation with propofol, and has considerable advantages compared with conventional sedation for endoscopy.
authors.affiliation: Department of Anesthesiology, Gentofte Hospital, University of Copenhagen, Denmark.
authors.forename: J T
authors.initials: JT
authors.lastname: Jensen
authors.forename: P
authors.initials: P
authors.lastname: Vilmann
authors.forename: T
authors.initials: T
authors.lastname: Horsted
authors.forename: P
authors.initials: P
authors.lastname: Hornslet
authors.forename: U
authors.initials: U
authors.lastname: Bodtger
authors.forename: A
authors.initials: A
authors.lastname: Banning
authors.forename: A
authors.initials: A
authors.lastname: Hammering
mesh_terms: D000328:Adult; D000368:Aged; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects / Q000379:methods / Q000451:nursing; D002983:Clinical Competence; D054810:Deep Sedation / Q000009:adverse effects* / Q000379:methods / Q000451:nursing*; D004509:Education, Nursing, Continuing; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects / Q000379:methods / Q000451:nursing; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D007022:Hypotension / Q000209:etiology; D000860:Hypoxia / Q000209:etiology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D015742:Propofol / Q000008:administration & dosage*; D018570:Risk Assessment
chemical_list: D006993:Hypnotics and Sedatives; D015742:Propofol