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Propofol sedation during endoscopic procedures: how much staff and monitoring are necessary?
Gastrointest Endosc. 2007 Sep; 66(3):443-9.GE

Abstract

BACKGROUND

Propofol has been shown to be safe for nonanesthetist use during GI endoscopy. However, published studies involved propofol administration by an additional nurse or used specialized patient monitoring or were carried out in tertiary hospitals.

OBJECTIVE

Considering the downward pressure on reimbursement for endoscopic procedures, we asked how much staff and monitoring is necessary for safe use of propofol.

SETTING

Two private gastroenterology practices.

PATIENTS AND DESIGN

A total of 27,061 endoscopic procedures (14,856 EGDs and 12,205 colonoscopies) were prospectively assessed regarding patient characteristics, American Society of Anesthesiologists (ASA) status, dosage of propofol, fall of oxygen saturation below 90%, need to increase nasal oxygen administration above 2 L/min, and need for assisted ventilation.

INTERVENTION

Propofol was administered by the endoscopy nurse supervised by the endoscopist. Patient monitoring consisted of only pulse oximetry and clinical assessment.

RESULTS

The mean propofol dose for EGD was 161 mg (range 50-650 mg). During colonoscopy patients received a mean propofol dose of 116 mg (30-500 mg) in addition to 25 mg of meperidine. Oxygen saturation fell below 90% (lowest 74%) in 623 procedures (2.3%), normalizing within less than 30 seconds by stimulating the patient and increasing the nasal oxygen flow to 4 to 10 L/min. Six patients (ASA III) required mask ventilation for less than 30 seconds. No endotracheal intubation was necessary.

LIMITATIONS

There was no further follow-up regarding adverse events after patient discharge from the endoscopy unit.

CONCLUSIONS

An endoscopy team, consisting of 1 physician endoscopist and 1 endoscopy nurse, can safely administer propofol sedation for GI endoscopy in a practice setting without additional staff or specialized monitoring.

Authors+Show Affiliations

Praxis für Gastroenterologie und Endoskopie, Zürich, Switzerland.No affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

17725933

Citation

Külling, Daniel, et al. "Propofol Sedation During Endoscopic Procedures: How Much Staff and Monitoring Are Necessary?" Gastrointestinal Endoscopy, vol. 66, no. 3, 2007, pp. 443-9.
Külling D, Orlandi M, Inauen W. Propofol sedation during endoscopic procedures: how much staff and monitoring are necessary? Gastrointest Endosc. 2007;66(3):443-9.
Külling, D., Orlandi, M., & Inauen, W. (2007). Propofol sedation during endoscopic procedures: how much staff and monitoring are necessary? Gastrointestinal Endoscopy, 66(3), 443-9.
Külling D, Orlandi M, Inauen W. Propofol Sedation During Endoscopic Procedures: How Much Staff and Monitoring Are Necessary. Gastrointest Endosc. 2007;66(3):443-9. PubMed PMID: 17725933.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Propofol sedation during endoscopic procedures: how much staff and monitoring are necessary? AU - Külling,Daniel, AU - Orlandi,Marcello, AU - Inauen,Werner, PY - 2006/11/18/received PY - 2007/01/21/accepted PY - 2007/8/30/pubmed PY - 2007/12/7/medline PY - 2007/8/30/entrez SP - 443 EP - 9 JF - Gastrointestinal endoscopy JO - Gastrointest Endosc VL - 66 IS - 3 N2 - BACKGROUND: Propofol has been shown to be safe for nonanesthetist use during GI endoscopy. However, published studies involved propofol administration by an additional nurse or used specialized patient monitoring or were carried out in tertiary hospitals. OBJECTIVE: Considering the downward pressure on reimbursement for endoscopic procedures, we asked how much staff and monitoring is necessary for safe use of propofol. SETTING: Two private gastroenterology practices. PATIENTS AND DESIGN: A total of 27,061 endoscopic procedures (14,856 EGDs and 12,205 colonoscopies) were prospectively assessed regarding patient characteristics, American Society of Anesthesiologists (ASA) status, dosage of propofol, fall of oxygen saturation below 90%, need to increase nasal oxygen administration above 2 L/min, and need for assisted ventilation. INTERVENTION: Propofol was administered by the endoscopy nurse supervised by the endoscopist. Patient monitoring consisted of only pulse oximetry and clinical assessment. RESULTS: The mean propofol dose for EGD was 161 mg (range 50-650 mg). During colonoscopy patients received a mean propofol dose of 116 mg (30-500 mg) in addition to 25 mg of meperidine. Oxygen saturation fell below 90% (lowest 74%) in 623 procedures (2.3%), normalizing within less than 30 seconds by stimulating the patient and increasing the nasal oxygen flow to 4 to 10 L/min. Six patients (ASA III) required mask ventilation for less than 30 seconds. No endotracheal intubation was necessary. LIMITATIONS: There was no further follow-up regarding adverse events after patient discharge from the endoscopy unit. CONCLUSIONS: An endoscopy team, consisting of 1 physician endoscopist and 1 endoscopy nurse, can safely administer propofol sedation for GI endoscopy in a practice setting without additional staff or specialized monitoring. SN - 0016-5107 UR - https://www.unboundmedicine.com/medline/citation/17725933/Propofol_sedation_during_endoscopic_procedures:_how_much_staff_and_monitoring_are_necessary DB - PRIME DP - Unbound Medicine ER -