Background and Aims
The safety of endoscopist-directed nurse-administered propofol sedation (EDNAPS) has
been demonstrated in low-risk patients (American Society of Anesthesiologists [ASA]
class I and II). There are limited data regarding the safety of EDNAPS for endoscopic
procedures in ASA class III patients. The purpose of this study was to determine the
safety of EDNAPS for routine outpatient endoscopy in this population.
Methods
We retrospectively reviewed all outpatient EGDs and colonoscopies performed with EDNAPS
at the University of Utah from January 2015 to November 2018. Exclusion criteria were
inpatient procedures, combined procedures, ASA IV or higher, use of continuous or
bilevel positive airway pressure at the start of the procedure, or procedures performed
by a nongastroenterologist. Major adverse events were defined as intubation or death.
Minor adverse events were defined as hypoxia, hypotension, bradycardia, or need for
airway interventions. Patients were stratified by procedure type and ASA I/II status
and were compared with patients with ASA III status and matched according to age,
gender, and the involvement of a fellow in a 3 to 1 fashion.
Results
The final sample size was 18,910 colonoscopy procedures (17,205 patients) and 9178
EGD procedures (6827 patients). In both colonoscopy and EGD procedures, there were
no major adverse events such as intubation, need for resuscitation, or death. The
rates of any airway intervention, jaw thrust, oral nasal airway, or use of positive
pressure ventilation were low in both procedure types and not different between ASA
I/II and ASA III patients.
Conclusion
EDNAPS is safe in both ASA I/II and ASA class III patients undergoing routine outpatient
endoscopy.
Abbreviations:
ASA (American Society of Anesthesiologists), BMI (body mass index), EDNAPS (endoscopist-directed nurse-administered propofol sedation)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Gastrointestinal EndoscopyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Anesthesia service use during outpatient gastroenterology procedures continued to increase from 2010 to 2013 and potentially discretionary spending remained high.Am J Gastroenterol. 2017; 112: 297-302
- Endoscopist-administered propofol sedation is safe - a prospective evaluation of 10,000 patients in an outpatient practice.J Gastrointestin Liver Dis. 2012; 21: 259-263
- Technical performance of colonoscopy in patients sedated with nurse-administered propofol.Am J Gastroenterol. 2004; 99: 52-56
- Nonanesthesiologist-administered propofol sedation for colonoscopy is safe and effective: a prospective Spanish study over 1000 consecutive exams.Eur J Gastroenterol Hepatol. 2012; 24: 787-792
- No increased risk of perforation during colonoscopy in patients undergoing Nurse Administered Propofol Sedation.Scand J Gastroenterol. 2013; 48: 1333-1338
- Endoscopist-directed administration of propofol: a worldwide safety experience.Gastroenterology. 2009; 137: 1229-1237
- Trained registered nurses/endoscopy teams can administer propofol safely for endoscopy.Gastroenterology. 2005; 129: 1384-1391
- Safety of propofol administered by registered nurses with gastroenterologist supervision in 2000 endoscopic cases.Am J Gastroenterol. 2002; 97: 1159-1163
- Quality of sedation with propofol administered by non-anesthetists in a digestive endoscopy unit: the results of a one year experience.Rev Esp Enferm Dig. 2006; 98: 25-35
- Assessing the safety of physician-directed nurse-administered propofol sedation in low-risk patients undergoing endoscopy and colonoscopy.Endosc. Int Open. 2017; 05: E110-E115
- Safety and effectiveness of nurse-administered propofol sedation in outpatients undergoing gastrointestinal endoscopy.Clin Gastroenterol Hepatol. 2019; 17: 1098-1104.e1
- Propofol versus midazolam/meperidine for outpatient colonoscopy: administration by nurses supervised by endoscopists.Gastrointest Endosc. 2002; 55: 815-825
- Nurse-administered propofol sedation for gastrointestinal endoscopic procedures: first Nordic results from implementation of a structured training program.Scand J Gastroenterol. 2011; 46: 1503-1509
- Risk stratification and safe administration of propofol by registered nurses supervised by the gastroenterologist: a prospective observational study of more than 2000 cases.Gastrointest Endosc. 2003; 57: 664-671
- Propofol sedation during endoscopic procedures: Safe and effective administration by registered nurses supervised by endoscopists.Endoscopy. 2006; 38: 360-367
- Nurse-administered propofol sedation without anesthesia specialists in 9152 endoscopic cases in an ambulatory surgery center.Am J Gastroenterol. 2003; 98: 1744-1750
- Nurse-administered propofol versus midazolam and meperidine for upper endoscopy in cirrhotic patients.Am J Gastroenterol. 2003; 98: 2440-2447
- Safety of propofol for conscious sedation during endoscopic procedures in high-risk patients-a prospective, controlled study.Am J Gastroenterol. 2003; 98: 1751-1757
- Conscious sedation with propofol in elderly patients: a prospective evaluation.Aliment Pharmacol Ther. 2003; 17: 1493-1501
- Nurse administered propofol sedation for pulmonary endoscopies requires a specific protocol.Dan Med J. 2012; 59: A4467
- Moderate and deep nurse-administered propofol sedation is safe.Dan Med J. 2015; 62: A5049
- Propofol versus midazolam and meperidine for conscious sedation in GI endoscopy.Am J Gastroenterol. 2000; 95: 1476-1479
- Propofol sedation during endoscopic procedures: how much staff and monitoring are necessary?.Gastrointest Endosc. 2007; 66: 443-449
- Quality of sedation with propofol administered by non-anesthetists in a digestive endoscopy unit: the results of a one year experience.Rev Esp Enferm Dig. 2018; 110: 231-236
- Nurse-administered propofol sedation for endoscopy: a risk analysis during an implementation phase.Endoscopy. 2011; 43: 716-722
- Review article: Registered nurse-administered propofol sedation for endoscopy.Aliment Pharmacol Ther. 2004; 19: 147-155
- Statement on Safe Use of Propofol.(Available at:)https://www.asahq.org/standards-and-guidelines/statement-on-safe-use-of-propofolDate: 2014Date accessed: September 29, 2020
- A retrospective study of nurse-assisted propofol sedation in patients with amyotrophic lateral sclerosis undergoing percutaneous endoscopic gastrostomy.Nutr Clin Pract. 2012; 27: 540-544
- Nurse-administered propofol sedation is safe for patients with obstructive sleep apnea undergoing routine endoscopy: a pilot study.Dig Dis Sci. 2011; 56: 2666-2671
- Continuum of Depth of Sedation: Definition of General Anesthesia and Levels of Sedation/Analgesia.(Available at:)https://www.asahq.org/standards-and-guidelines/continuum-of-depth-of-sedation-definition-of-general-anesthesia-and-levels-of-sedationanalgesiaDate: 1999Date accessed: September 29, 2020
- A systematic review and meta-analysis of randomized, controlled trials of moderate sedation for routine endoscopic procedures.Gastrointest Endosc. 2008; 67: 910-923
- Non-anesthesiologist administration of propofol for gastrointestinal endoscopy: European Society of Gastrointestinal Endoscopy, European Society of Gastroenterology and Endoscopy Nurses and Associates guideline - updated June 2015.Endoscopy. 2015; 47: 1175-1189
- Guidelines for sedation and anesthesia in GI endoscopy.Gastrointest Endosc. 2018; 87: 327-337
Article info
Publication history
Published online: December 10, 2020
Accepted:
November 28,
2020
Received:
May 28,
2020
Footnotes
If you would like to chat with an author of this article, you may contact Dr Gawron at [email protected]
DISCLOSURE: Dr Fang has done consultancy work with Merit Medical and Boston Scientific. All other authors disclosed no financial relationships.
Identification
Copyright
© 2021 by the American Society for Gastrointestinal Endoscopy
ScienceDirect
Access this article on ScienceDirectLinked Article
- Safety of endoscopist-directed nurse-administered balanced propofol sedation in patients with severe systemic disease (ASA class III)Gastrointestinal EndoscopyVol. 93Issue 6
- PreviewWe read with interest the article by McKenzie et al1 on the safety of endoscopist-directed nurse-administered propofol (EDNAP) sedation. As with other innovative procedural sedation techniques (such as patient-maintained propofol sedation),2-4 understanding the risks and benefits of EDNAP sedation is vital for patient safety, and the authors deserve credit for their useful addition to the literature. Nevertheless, we believe there are important limitations to their study methodology that might affect the validity of their conclusions.
- Full-Text
- Preview
- Endoscopist-directed nurse-administered balanced propofol sedation for ASA class III patients: A safety net for a tough balancing act?Gastrointestinal EndoscopyVol. 94Issue 1
