Recent studies have documented the safety of propofol sedation for endoscopic procedures.
However, many endoscopists are reluctant to use propofol for high-risk patients because of adverse effects.
Dr Tohda and colleagues from Japan demonstrated the safety of nurse-administered propofol sedation during emergency upper endoscopy for gastrointestinal (GI) bleeding.
Over a period of 18 months, 120 patients suffering from acute upper gastrointestinal bleeding received propofol sedation administered by a nurse.
Among these, the team classified 15 patients into American Society of Anesthesiologists class IV.
The research team noted that 84 patients were class III, and 21 were class II of the classification of the American Society of Anesthesiologists.
|Endoscopic hemostasis was achieved in 98% of patients|
Patients without gastrointestinal bleeding, who also received propofol during the same period and were matched for age, gender, and classification, served as controls.
The researchers found that endoscopic hemostasis was achieved in 98% of patients, and 98% were satisfied with the procedure.
In patients with gastrointestinal bleeding, the rates of hypotension and hypoxemia were 8% and 7% respectively.
The team observed that these values were higher than those in the control group.
However, neither mask ventilation nor endotracheal intubation was necessary.
The team found that 2 patients with gastrointestinal bleeding developed pneumonia, most likely due to aspiration during the procedure.
These patients recovered within 5 days of treatment.
There were no sedation-associated severe complications or mortalities.
Dr Tohda's team concludes, “Using a strict protocol designed to protect the patient's airway and cardiovascular function, nurse-administered propofol sedation during emergency upper gastrointestinal endoscopy is safe and appropriate in cases of acute gastrointestinal bleeding.”