Endoscopist-directed balanced propofol sedation is safe and effective in patients undergoing outpatient colonoscopy
| Autor: | Iyad Khamaysi, Ian M. Gralnek, Amir Klein, Joseph H. Nathan |
|---|---|
| Rok vydání: | 2015 |
| Předmět: |
moderate sedation
medicine.medical_specialty Sedation Colonoscopy Fentanyl 03 medical and health sciences 0302 clinical medicine colonoscopy medicine endoscopy lcsh:RC799-869 balanced propofol sedation General Environmental Science propofol medicine.diagnostic_test business.industry conscious sedation Fecal occult blood Retrospective cohort study anesthesiology Surgery Regimen 030220 oncology & carcinogenesis Anesthesia monitored anesthesia care Midazolam lcsh:Diseases of the digestive system. Gastroenterology 030211 gastroenterology & hepatology medicine.symptom business Propofol medicine.drug |
| Zdroj: | Journal of Digestive Endoscopy, Vol 6, Iss 04, Pp 158-162 (2015) |
| ISSN: | 0976-5050 0976-5042 |
| DOI: | 10.4103/0976-5042.173961 |
| Popis: | Background and Aims: Propofol administered in combination with other moderate sedation medications (balanced propofol sedation [BPS]) is an appealing and effective sedation regimen for gastrointestinal (GI) endoscopy procedures. However, product labeling dictates propofol be administered only by anesthesiology personnel. We evaluated the safety of endoscopist-directed as well as anesthesiologist-administered BPS during outpatient colonoscopy. Methods: We performed a retrospective cohort study using prospectively collected endoscopy data where endoscopist-directed BPS is standard practice. Measured patient outcomes included: BPS drug dosages, postcolonoscopy oxygen saturation levels, pulse, and systolic/diastolic blood pressures, need for mask bag ventilation or endotracheal intubation, aborted colonoscopy due to sedation, hospital admission postcolonoscopy, and mortality. Results: From April 1 to November 30, 2013, 1036 patients undergoing outpatient colonoscopy (mean age 56.4 years, 55% males, 32% American Society of Anesthesiologists [ASA] I, 59% ASA II, 9% ASA III) received endoscopist-directed BPS. During the same time period, 40 patients (mean age 66.6 years, 55% males, 33% ASA II, 67% ASA III) received anesthesiologist-administered BPS. Indications for colonoscopy for the endoscopist-directed BPS included 352 (34%) colorectal cancer screening/surveillance, 404 (39%) evaluation of lower GI symptoms, 156 (15%) positive fecal occult blood, and 124 (12%) inflammatory bowel disease. BPS dosages (mean ± standard deviation) per patient were Fentanyl 0.05 mg (fixed dose), midazolam 1.6 mg ± 0.5 mg (range: 1-5 mg), and propofol 104 mg ± 62 mg (range: 10-460 mg). Propofol doses correlated inversely with patient age (r = −0.35; P < 0.001), and the mean Propofol dose was lower as ASA score increased: ASA I - 115 mg, ASA II - 103 mg, and ASA III - 75 mg (P < 0.01). No patient required bag mask ventilation, endotracheal intubation, or hospital admission. There were no aborted colonoscopies secondary to sedation and no mortality. All patients were discharged directly to home. Conclusions: Endoscopist-directed BPS appears safe and effective for low-, intermediate- and high-risk patients undergoing outpatient colonoscopy. |
| Databáze: | OpenAIRE |
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