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Sedation with propofol for interventional endoscopy by trained nurses in high-risk octogenarians: a prospective, randomized, controlled study.
Endoscopy. 2009 Apr; 41(4):295-8.E

Abstract

BACKGROUND AND STUDY AIMS

Sedation with the short-acting anesthetic agent propofol has shown several advantages, particularly in interventional endoscopy. So far, however, there are no valid data on the safety of nurse-administered propofol sedation (NAPS) during interventional endoscopy in elderly high-risk patients.

PATIENTS AND METHODS

A total of 150 patients aged > 80 years with high comorbidity were randomized to receive midazolam plus meperidine (n = 75) or propofol alone (n = 76) for sedation during endoscopic retrograde cholangiopancreatography (ERCP), endoscopic ultrasound (EUS), or double-balloon endoscopy (DBE). Sedation was supervised by a trained nurse and a trained physician both of whom were not involved in the endoscopic procedure. Vital signs were continuously monitored as well as patient cooperation and tolerance. Mortality and morbidity at 30 days was analyzed.

RESULTS

The overall cardiopulmonary complication rate was 16 % in the midazolam group and 23.7 % in the propofol group (P > 0.05). The mean decline in oxygen saturation (initial vs. lowest O (2) saturation) and the mean decline of blood pressure (initial vs. lowest blood pressure) were significantly greater with propofol (7 % +/- 3 % vs. 4 % +/- 2 % [ P < 0.05] and 10 % +/- 2 % vs. 8 % +/- 2 %, respectively [ P < 0.05]). No procedure had to be interrupted due to serious adverse events. Patient cooperation was statistically significantly better in the propofol group (7 +/- 2 vs. 5 +/- 2 points). Patients sedated with propofol showed a significantly lower oxygen saturation rate during recovery time (8 % vs. 28 %; P < or = 0.01).

CONCLUSION

NAPS during interventional endoscopy is as safe as midazolam/pethidine sedation even in high-risk patients aged > 80 years.

Authors+Show Affiliations

Department of Gastroenterology and Interventional Endoscopy, Diakonie Hospital Mannheim, Germany. D.schilling@diako-ma.deNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

19340730

Citation

Schilling, D, et al. "Sedation With Propofol for Interventional Endoscopy By Trained Nurses in High-risk Octogenarians: a Prospective, Randomized, Controlled Study." Endoscopy, vol. 41, no. 4, 2009, pp. 295-8.
Schilling D, Rosenbaum A, Schweizer S, et al. Sedation with propofol for interventional endoscopy by trained nurses in high-risk octogenarians: a prospective, randomized, controlled study. Endoscopy. 2009;41(4):295-8.
Schilling, D., Rosenbaum, A., Schweizer, S., Richter, H., & Rumstadt, B. (2009). Sedation with propofol for interventional endoscopy by trained nurses in high-risk octogenarians: a prospective, randomized, controlled study. Endoscopy, 41(4), 295-8. https://doi.org/10.1055/s-0028-1119671
Schilling D, et al. Sedation With Propofol for Interventional Endoscopy By Trained Nurses in High-risk Octogenarians: a Prospective, Randomized, Controlled Study. Endoscopy. 2009;41(4):295-8. PubMed PMID: 19340730.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Sedation with propofol for interventional endoscopy by trained nurses in high-risk octogenarians: a prospective, randomized, controlled study. AU - Schilling,D, AU - Rosenbaum,A, AU - Schweizer,S, AU - Richter,H, AU - Rumstadt,B, Y1 - 2009/04/01/ PY - 2009/4/3/entrez PY - 2009/4/3/pubmed PY - 2009/6/26/medline SP - 295 EP - 8 JF - Endoscopy JO - Endoscopy VL - 41 IS - 4 N2 - BACKGROUND AND STUDY AIMS: Sedation with the short-acting anesthetic agent propofol has shown several advantages, particularly in interventional endoscopy. So far, however, there are no valid data on the safety of nurse-administered propofol sedation (NAPS) during interventional endoscopy in elderly high-risk patients. PATIENTS AND METHODS: A total of 150 patients aged > 80 years with high comorbidity were randomized to receive midazolam plus meperidine (n = 75) or propofol alone (n = 76) for sedation during endoscopic retrograde cholangiopancreatography (ERCP), endoscopic ultrasound (EUS), or double-balloon endoscopy (DBE). Sedation was supervised by a trained nurse and a trained physician both of whom were not involved in the endoscopic procedure. Vital signs were continuously monitored as well as patient cooperation and tolerance. Mortality and morbidity at 30 days was analyzed. RESULTS: The overall cardiopulmonary complication rate was 16 % in the midazolam group and 23.7 % in the propofol group (P > 0.05). The mean decline in oxygen saturation (initial vs. lowest O (2) saturation) and the mean decline of blood pressure (initial vs. lowest blood pressure) were significantly greater with propofol (7 % +/- 3 % vs. 4 % +/- 2 % [ P < 0.05] and 10 % +/- 2 % vs. 8 % +/- 2 %, respectively [ P < 0.05]). No procedure had to be interrupted due to serious adverse events. Patient cooperation was statistically significantly better in the propofol group (7 +/- 2 vs. 5 +/- 2 points). Patients sedated with propofol showed a significantly lower oxygen saturation rate during recovery time (8 % vs. 28 %; P < or = 0.01). CONCLUSION: NAPS during interventional endoscopy is as safe as midazolam/pethidine sedation even in high-risk patients aged > 80 years. SN - 1438-8812 UR - https://www.unboundmedicine.com/medline/citation/19340730/Sedation_with_propofol_for_interventional_endoscopy_by_trained_nurses_in_high_risk_octogenarians:_a_prospective_randomized_controlled_study_ L2 - http://www.thieme-connect.com/DOI/DOI?10.1055/s-0028-1119671 DB - PRIME DP - Unbound Medicine ER -