title: Nonanesthesiologist-administered propofol sedation for colonoscopy is safe and effective:  a prospective Spanish study over 1000 consecutive exams.
abstract: OBJECTIVE
  Propofol is increasingly being used in sedated colonoscopy. This paper assesses the safety and efficacy of nonanesthesiologist-administered propofol in a large series of colonoscopies.
  
  
  METHODS
  A prospective registry of consecutive American Society of Anesthetics (ASA) class I and II outpatients undergoing colonoscopy was carried out. Propofol, administered by a nurse under an endoscopist's supervision, was the sole sedative agent used.
  
  
  RESULTS
  Of the 1000 patients (563 women/437 men, mean age 57, range 8-89 years) included in the study, 57.4% showed ASA I and 42.6% ASA II characteristics. The cecal intubation rate was 96.9%. 48.2% of the procedures were for therapeutic purposes. The mean propofol dose was 177 mg (range 50-590 mg). Doses correlated inversely with patient age (r=-0.38; P<0.001) and were lower in ASA II patients (P<0.001) and in diagnostic (rather than therapeutic) exams (P<0.001). The average recovery time (from extracting the colonoscope to patient discharge) was 18.6 min (range 4-75) and longer in ASA II patients (P=0.05). A pulse oximetry saturation of less than 90% and a decrease in systolic blood pressure of more than 20 mmHg were observed in 24 (2.4%) and 385 (35.8%) patients, respectively. Both events were more frequent in patients older than 65 years (P<0.05); the latter was more common in ASA II patients.
  
  
  CONCLUSIONS
  Colonoscopy under endoscopist-controlled propofol sedation in low-risk patients is safe and effective, allowing for a complete exploration, although patients at least 65 years old and/or classified as ASA II are more likely to present a decrease in blood pressure and have a prolonged recovery time.
authors.affiliation: Department of Gastroenterology, Tomelloso General Hospital, Tomelloso, Spain. alucendo@vodafone.es
authors.forename: Alfredo J
authors.initials: AJ
authors.lastname: Lucendo
authors.forename: Antonio
authors.initials: A
authors.lastname: Olveira
authors.forename: Ana Belén
authors.initials: AB
authors.lastname: Friginal-Ruiz
authors.forename: Danila
authors.initials: D
authors.lastname: Guagnozzi
authors.forename: Teresa
authors.initials: T
authors.lastname: Angueira
authors.forename: Mariluz
authors.initials: M
authors.lastname: Fernández-Fuente
authors.forename: Mercedes
authors.initials: M
authors.lastname: Cruz-Campos
authors.forename: Mercedes
authors.initials: M
authors.lastname: Serrano-Valverde
authors.forename: Marta
authors.initials: M
authors.lastname: Sánchez-Cazalilla
authors.forename: José M
authors.initials: JM
authors.lastname: Tenias
authors.forename: Sonia
authors.initials: S
authors.lastname: González-Castillo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001285:Atropine / Q000627:therapeutic use; D002648:Child; D003113:Colonoscopy / Q000009:adverse effects* / Q000379:methods; D016292:Procedural Sedation / Q000009:adverse effects* / Q000379:methods / Q000451:nursing; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D015742:Propofol / Q000008:administration & dosage / Q000009:adverse effects*; D011446:Prospective Studies; D055815:Young Adult
chemical_list: D000889:Anti-Arrhythmia Agents; D006993:Hypnotics and Sedatives; D001285:Atropine; D015742:Propofol