Propofol is increasingly being used for sedation during enoscopy as an alternative to narcotics and benzodiazepines.
Howver, many endoscopists are reluctant to use propofol in critically ill patients due to the possibility of serious adverse effects including respiratory and cardiovascular depression.
A new study, published in The American Journal of Gastroenterology has investigated the safety of propofol sedation during endoscopy in high-risk, critically ill patients.
Dr Ludwig Heuss and colleagues have compared the outcome of propofol sedation in high-risk patients with the outcome in low-risk patients.
Patients were grouped according to the American Society of Anesthesiologists (ASA) classification. High-risk patients were those in ASA class III or IV. Low-risk patients were those in ASA class I or II.
During a 19-month period, 1370 high-risk patients were sedated with propofol. 642 of these patients were matched with 642 consecutive patients of the same gender and age assigned to ASA classes I and II and undergoing the same endoscopic procedures.
Propofol sedation was performed by registered nurses, who also carefully monitored arterial oxygen saturation, heart rate, and blood pressure.
No major complications occurred among the critically ill patients.
However, an increased risk for a short relevant oxygen desaturation (<<>90%) was seen in the high-risk patients than in the low-risk patients
Short mask ventilation was necessary in 4 high-risk patient and only 1 low-risk patient.
There was no pronounced influence on arterial pressure or heart rate and no perforations in 336 colonoscopies in critically ill patients.
The required dose of propofol was, on average,10-20% lower in high-risk patients than in low-risk patients.
Dr Heuss concludes. "With careful monitoring, propofol sedation during GI endoscopies is safe, even for high-risk patients."
| There were no major complication after propofol sedation in 642 consecutive critically ill patients.|
|American Journal of Gastroenterology|
"Considering their higher comorbidity and tendency toward oxygen desaturation, criticlally ill patients need particularly careful monitoring."