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.
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.
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.
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)
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Published online: December 10, 2020
Accepted: November 28, 2020
Received: May 28, 2020
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.
© 2021 by the American Society for Gastrointestinal Endoscopy
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- 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.
- Endoscopist-directed nurse-administered balanced propofol sedation for ASA class III patients: A safety net for a tough balancing act?Gastrointestinal EndoscopyVol. 94Issue 1