my personal edition > gastro other > news
E-Mail this DGDispatch to a colleague
DGDispatch
Propofol Sedation Is Safe When Administered By Nonanaesthesiologists for Endoscopic Procedures: Presented at DDW
By Bruce Sylvester
SAN DIEGO -- May 26, 2008 -- Administration of propofol sedation by nonanaesthesiologists for endoscopic procedures is controversial, but its safety was confirmed in a study reported here at Digestive Diseases Week 2008 (DDW).
"We did a very large review of data on such procedures, and we found that nonanaesthesiologist-administered propofol sedation is safe," said presenter and investigator Douglas Rex, MD, Professor of Medicine, Indiana University School of Medicine, and Director of Endoscopy, Indiana University Hospital, Indianapolis, Indiana.
The authors noted, "Propofol administration for endoscopic procedures by anaesthesia specialists is costly. Nonanaesthesiologist-administered propofol sedation (NAP) is rapidly evolving but is controversial due to concerns about safety -- mainly respiratory depression."
Therefore, Dr. Rex and colleagues conducted a literature review to determine the overall number of endotracheal intubations, neurological injuries, deaths, and mask ventilations associated with NAP for endoscopic procedures. The results of the review were presented on May 22.
The investigators gathered all published abstracts and papers on studies in which NAP was used for endoscopic procedures -- a total of 456,918 (213,527 published and 243,391 unpublished) NAP procedures. All gastroenterologists known to be performing NAP for endoscopy were asked to participate in the review.
From relevant data available for all NAP patients, they found 3 endotracheal intubations, 1 neurological injury, and 3 deaths.
Death occurred in a patient with widely metastatic pancreatic cancer, a severely handicapped patient with mental retardation, and a patient with an extensive history of substance abuse. In 2 of the 3 deaths, the family decided to withdraw life support.
Mask ventilation was required in 322 out of 400,769 cases (from which data were available).
Fifty of 123,768 esophagogastroduodenoscopy (EGD) patients and 11 of 97,429 colonoscopy patients required mask ventilation during their EGD or colonoscopy (P < .001). The type of procedure used was unclear from the records of the remaining 261 patients requiring mask ventilation.
"The administration of propofol by nonanaesthesiologists for endoscopic procedures is safe," the authors concluded. "Mask ventilation was required more frequently with [esophagogastroduodenoscopy] EGDs compared to colonoscopies."
"NAP is one feasible solution to the high costs associated with anaesthesiologist-delivered sedation for endoscopy," they added.
[Presentation title: Non-Anesthesiologist Administered Propofol Sedation for Endoscopic Procedures: A Worldwide Safety Review. Abstract 883]
All contents Copyright (c) 1995-2010 Doctor's Guide Publishing Limited. All rights reserved.
| 
