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.
Dr Daniel Külling and colleagues from Switzerland considered the downward pressure on reimbursement for endoscopic procedures.
The researchers assessed how much staff and monitoring is necessary for safe use of propofol.
|Oxygen saturation fell below 90% in 2% of procedures|
The team observed it at 2 private gastroenterology practices.
The team assessed a total of 27,061 endoscopic procedures, 14,856 esophagogastroduodenoscopies and 12,205 colonoscopies regarding patient characteristics.
American Society of Anesthesiologists status, dosage of propofol, and fall of oxygen saturation below 90% were measured.
In addition, the team measured need to increase nasal oxygen administration above 2 L/min, and need for assisted ventilation.
Propofol was administered by the endoscopy nurse supervised by the endoscopist.
Patient monitoring consisted of only pulse oximetry and clinical assessment.
The researchers found that the mean propofol dose for esophagogastroduodenoscopy was 161 mg.
During colonoscopy patients received a mean propofol dose of 116 mg in addition to 25 mg of meperidine.
Oxygen saturation fell below 90% in 2% of procedures.
The team observed that this normalized within less than 30 seconds by stimulating the patient and increasing the nasal oxygen flow to 4 to 10 L/min.
The researchers found that 6 patients required mask ventilation for less than 30 seconds.
No endotracheal intubation was necessary.
The team noted there was no further follow-up regarding adverse events after patient discharge from the endoscopy unit.
Dr Külling's team concluded, "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."