Safety of Non-anesthesia Provider-Administered Propofol (NAAP) Sedation in Advanced Gastrointestinal Endoscopic Procedures: Comparative Meta-Analysis of Pooled Results.
OBJECTIVE
The aim of the study was to evaluate the safety of non-anesthesia provider (NAAP)-administered propofol sedation for advanced endoscopic procedures with those of anesthesia provider (AAP).


METHODS
PubMed, EMBASE, Cochrane Central Register of Controlled Trials, Scopus, and Web of Science databases were searched for prospective observational trials involving advanced endoscopic procedures. From a total of 519 publications, 26 were identified to meet inclusion criteria (10 AAPs and 16 NAAPs) and were analyzed. Data were analyzed for hypoxia rate, airway intervention rates, endoscopist, and patient satisfaction scores and total propofol administered.


RESULTS
Total number of procedures in NAAP and AAP groups was 3018 and 2374, respectively. Pooled hypoxia (oxygen saturation less than 90 %) rates were 0.133 (95 % CI 0.117-0.152) and 0.143 (95 % CI 0.128-0.159) in NAAP and AAP, respectively. Similarly, pooled airway intervention rates were 0.035 (95 % CI 0.026-0.047) and 0.133 (95 % CI 0.118-0.150), respectively. Pooled patient satisfaction rate, pooled endoscopist satisfaction rate, and mean propofol administered dose for NAAP were 7.22 (95 % CI 7.17-7.27), 6.03 (95 % CI 5.94-6.11), and 251.44 mg (95 % CI 244.39-258.49) in that order compared with 9.82 (95 % CI 9.76-9.88), 9.06 (95 % CI 8.91-9.21), and 340.32 mg (95 % CI 327.30-353.33) for AAP.


CONCLUSIONS
The safety of NAAP sedation compared favorably with AAP sedation in patients undergoing advanced endoscopic procedures. However, it came at the cost of decreased patient and endoscopist satisfaction.
Department of Anesthesia, Hospital of the University of Pennsylvania, Philadelphia, PA, USA, goudrab@uphs.upenn.edu.
Basavana Gouda
BG
Goudra
Preet Mohinder
PM
Singh
Gowri
G
Gouda
Anuradha
A
Borle
Divakara
D
Gouda
Amulya
A
Dravida
Vinay
V
Chandrashakhara
D000776:Anesthesiology; D001291:Attitude of Health Personnel; D054810:Deep Sedation / Q000009:adverse effects* / Q000379:methods; D016099:Endoscopy, Gastrointestinal; D005762:Gastroenterology; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000009:adverse effects*; D000860:Hypoxia / Q000139:chemically induced / Q000453:epidemiology; D009726:Nurses; D017060:Patient Satisfaction; D010819:Physician's Role; D015742:Propofol / Q000008:administration & dosage / Q000009:adverse effects*; D012121:Respiration, Artificial / Q000706:statistics & numerical data
D006993:Hypnotics and Sedatives; D015742:Propofol