Endoscopy cornerIncidence of Sedation-Related Complications With Propofol Use During Advanced Endoscopic Procedures
Section snippets
Methods
We performed a prospective analysis of patients undergoing advanced endoscopic procedures (ERCP, EUS, single-balloon or spiral overtube-assisted small-bowel enteroscopy and enteral stenting) at Washington University in St. Louis, a tertiary care medical center. In our endoscopy unit, standard practice is to sedate patients undergoing advanced procedures using propofol alone or in combination with low-dose opiate and/or benzodiazepine. Propofol dosing and patient monitoring is directed by a
Results
A total of 799 patients were enrolled over the 7-month study period, including 423 EUS patients (52.9%), 336 ERCP patients (42.1%), and 40 small-bowel enteroscopy or other patients (5.0%). Additional patient characteristics along with procedural and pharmacologic data are summarized in Table 2. Of note, 60.5% of patients met criteria for ASA class 3 or higher and 0.5% had a Mallampati score equal to 4. In addition, no response to endoscopic intubation was observed in 87.2% of cases, which would
Discussion
Propofol can be administered safely to patients undergoing advanced endoscopic procedures. In our series of 799 patients managed by CRNAs, we observed no major sedation-related complications, and our reported rates of hypoxemia (12.8%) and significant hypotension (0.5%) are comparable with published data.9, 10, 11, 12, 13, 14, 19, 20 Our study population is uniquely complex, with 61% of patients having an ASA class of 3 or higher and endoscopy times of 30 ± 19 minutes.
We report the frequency of
References (30)
- et al.
AGA Institute review of endoscopic sedation
Gastroenterology
(2007) - et al.
The changing landscape of practice patterns regarding unsedated endoscopy and propofol use: a national Web survey
Gastrointest Endosc
(2005) - et al.
Trained registered nurses/endoscopy teams can administer propofol safely for endoscopy
Gastroenterology
(2005) - et al.
Endoscopist administered propofol for upper-GI EUS is safe and effective: a prospective study in 500 patients
Gastrointest Endosc
(2004) - et al.
Gastroenterologist-administered propofol versus meperidine and midazolam for advanced upper endoscopy: a prospective, randomized trial
Gastroenterology
(2002) - et al.
Efficacy and safety of intravenous propofol sedation during routine ERCP: a prospective, controlled study
Gastrointest Endosc
(1999) - et al.
Bispectral index monitoring of conscious sedation with the combination of meperidine and midazolam during endoscopy
Clin Gastroenterol Hepatol
(2008) - et al.
Bispectral index monitoring of sedation during endoscopy
Gastrointest Endosc
(2000) - et al.
An assessment of computer-assisted personalized sedation: a sedation delivery system to administer propofol for gastrointestinal endoscopy
Gastrointest Endosc
(2008) - et al.
Target-controlled infusion during monitored anesthesia care in patients undergoing EUS: propofol alone versus midazolam plus propofolA prospective double-blind randomised controlled trial
Dig Liver Dis
(2007)
Target-controlled propofol infusion during monitored anesthesia in patients undergoing ERCP
Gastrointest Endosc
Endoscopic sedation in the United States: results from a nationwide survey
Am J Gastroenterol
Practice guidelines for sedation and analgesia by non-anesthesiologists
Anesthesiology
Propofol for intravenous sedation
Anaesthesia
Propofol sedation during endoscopic procedures: safe and effective administration by registered nurses supervised by endoscopists
Endoscopy
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Conflicts of interest The authors disclose no conflicts.