title: Endoscopic ultrasound sedation in the United Kingdom: Is life without propofol tolerable?
abstract: There is compelling evidence to support the quality, cost effectiveness and safety profile of non-anesthesiologist-administered propofol for endoscopic ultrasound (EUS). However in the United Kingdom, it is recommended that the administration and monitoring of propofol sedation for endoscopic procedures should be the responsibility of a dedicated and appropriately trained anaesthetist only. The majority of United Kingdom EUS procedures are performed with opiate and benzodiazepine sedation rather than anaesthetist led propofol lists due to anaesthetist resource availability. We sought to prospectively determine the tolerability and safety of EUS with benzodiazepine and opiate sedation in single United Kingdom centre. Two hundred consecutive patients undergoing either EUS or oesophago-gastroduodenoscopy (OGD) with conscious sedation were prospectively recruited with a 1:1 enrolment ratio. Patients completed questionnaires pre and post procedure detailing anticipated and actual pain experienced on a 1-10 visual analogue scale. Demographics, procedure duration, sedation doses and willingness to repeat the procedure were also recorded. EUS procedures lasted significantly longer than OGDs (15 minvs6 min,P< 0.0001), however, there was no difference in anticipated pain scores between the groups (EUS 3.37/10vsOGD 3.47/10,P= 0.46). Pain scores indicated EUS was better tolerated than OGD (1.16/10vs1.88/10,P= 0.03) although higher doses of sedation were used for EUS procedures. There were no complications identified in either group. We feel our study demonstrates that the tolerability of EUS with opiate and benzodiazepine sedation is acceptable.
authors.affiliation: Jennifer Anne Campbell, Andrew James Irvine, Andrew Derek Hopper, Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield S10 2JF, United Kingdom.
authors.forename: Jennifer Anne
authors.initials: JA
authors.lastname: Campbell
authors.affiliation: Jennifer Anne Campbell, Andrew James Irvine, Andrew Derek Hopper, Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield S10 2JF, United Kingdom.
authors.forename: Andrew James
authors.initials: AJ
authors.lastname: Irvine
authors.affiliation: Jennifer Anne Campbell, Andrew James Irvine, Andrew Derek Hopper, Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield S10 2JF, United Kingdom.
authors.forename: Andrew Derek
authors.initials: AD
authors.lastname: Hopper
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000008:administration & dosage; D000072080:Anesthesiologists; D016292:Procedural Sedation / Q000009:adverse effects / Q000191:economics / Q000379:methods* / Q000592:standards; D003362:Cost-Benefit Analysis; D016145:Endoscopy, Digestive System / Q000009:adverse effects* / Q000379:methods; D019160:Endosonography / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D008874:Midazolam / Q000008:administration & dosage; D008875:Middle Aged; D010146:Pain / Q000209:etiology / Q000517:prevention & control*; D010147:Pain Measurement; D017410:Practice Guidelines as Topic; D015742:Propofol / Q000008:administration & dosage* / Q000009:adverse effects; D011446:Prospective Studies; D018570:Risk Assessment; D011795:Surveys and Questionnaires; D013997:Time Factors; D006113:United Kingdom; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D006993:Hypnotics and Sedatives; D008874:Midazolam; D005283:Fentanyl; D015742:Propofol
keywords: Endoscopic ultrasound; Endoscopy; Propofol; Sedation; Tolerability