Download PDF
Endosc Int Open 2015; 03(05): E393-E397
DOI: 10.1055/s-0034-1392511
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Morbidity and mortality of endoscopist-directed nurse-administered propofol sedation (EDNAPS) in a tertiary referral center

Marie Ooi
The Canberra Hospital, Gastroenterology Unit, Canberra, Australian Capital Territory 2600, Australia
,
Andrew Thomson
The Canberra Hospital, Gastroenterology Unit, Canberra, Australian Capital Territory 2600, Australia
› Author Affiliations
Further Information

Publication History

Publication Date:
11 August 2015 (online)

Also available at
   Permissions and Reprints

Background and study aims: Endoscopist-Directed Nurse-Administered Propofol Sedation (EDNAPS) has been evaluated in community settings rather than tertiary referral centers.

Patients and methods: A hospital-wide prospectively collected database of Medical Emergency Team Calls (METCALL), emergency responses triggered by medically unstable patients, was reviewed. Responses that followed EDNAPS were extracted and compared with a prospectively entered database of all endoscopies performed using EDNAPS over the same period.

Results: A total of 33,539 endoscopic procedures (16,393 gastroscopies, 17,146 colonoscopies) were performed on 27,989 patients using EDNAPS. Intravenous drugs included midazolam (0 – 5 mg), fentanyl (0 – 100 mcg), and propofol (10 – 420 mg). Of 23 METCALLs (18 gastroscopies and 5 colonoscopies), there were 16 with ASA scores of III or higher. Indications for gastroscopy were gastrointestinal (GI) hemorrhage (n = 11; 8 variceal, 3 nonvariceal), dysphagia (n = 5), PEG removal (n = 1), and dyspepsia (n = 1). Fifteen of 22 patients, including all of those who had a colonoscopy, made a full recovery and returned to the ward or were discharged home. In the gastroscopy group, seven were intubated and admitted to Intensive Care, of whom six were emergency cases for gastrointestinal bleeding (n = 4 variceal, n = 2 non variceal) and one in which the indication was PEG removal. Two deaths occurred in the intubated group.

Conclusions: In a tertiary referral center, EDNAPS for low-to-moderate risk (ASA ≤ 2) patients undergoing gastroscopy and colonoscopy is very safe. Gastroscopy is associated with greater anesthetic risk than colonoscopy and those with high ASA scores needing urgent endoscopy for upper gastrointestinal hemorrhage are at particular risk of cardiorespiratory decompensation.

 

  • References

  • 1 Clarke A, Chiragakis L, Hillman LC et al. Sedation for endoscopy: the safe use of propofol by general practitioner sedationists. Med J Aust 2002; 176: 158-161
    PubMedGoogle Scholar
  • 2 Thomson A, Andrew G, Jones DB. Optimal sedation for gastrointestinal endoscopy: review and recommendations. J Gastroenterol Hepatol 2010; 25: 469-478
    CrossrefPubMedGoogle Scholar
  • 3 Rex DK, Deenadayalu VP, Eid E et al. Endoscopist-directed administration of propofol: a worldwide safety experience. Gastroenterology 2009 Oct 137: 1229-1237
    PubMedGoogle Scholar
  • 4 Vargo JJ, Zuccaro G, Dumot JA et al. Gastroenterologist-administered propofol versus meperidine and midazolam for advanced upper endoscopy: a prospective, randomized trial. Gastroenterology 2002; 123: 8-16
    CrossrefPubMedGoogle Scholar
  • 5 Bell GD, Charlton JE. Colonoscopy – is sedation necessary and is there any role for intravenous propofol? [Editorial]. Endoscopy 2000; 32: 264-267
    Article in Thieme ConnectPubMedGoogle Scholar
  • 6 Australian and New Zealand College of Anaesthetists and Gastroenterological Society of Australia. Sedation for endoscopy. Melbourne: ANZCA; 1997
    Google Scholar
  • 7 Kulling D, Orlandi M, Inauen W. Propofol sedation during endoscopic procedures: how much staff and monitoring are necessary?. Gastrointest Endosc 2007; 66: 443-449
    CrossrefPubMedGoogle Scholar
  • 8 Rex DK, Heuss LT, Walker JA et al. Trained registered nurses/endoscopy teams can administer propofol safely for endoscopy. Gastroenterology 2005; 129: 1384-1391
    CrossrefPubMedGoogle Scholar
  • 9 Kongkam P, Pornphisarn B, Rerknimitr R. Non-anaesthetist administered propofol for ERCP; efficacy, safety profile and side effect: a prospective randomized trial [abstract]. Gastrointest Endosc 2004; 59: AB127
    PubMedGoogle Scholar
  • 10 Gonzalez-Huix F, Aldeguer X, Fort E et al. Sedation without anaesthesiologist in 5250 endoscopic procedures: midazolam vs. midazolam vs. propofol [abstract]. Gastrointest Endosc 2004; 59: AB133
    PubMedGoogle Scholar
  • 11 Kulling D, Rothenbuhler R, Inauen W. Safety of nonanesthetist sedation with propofol for outpatient colonoscopy and esophagogastroduodenoscopy. Endoscopy 2003; 35: 679-682
    Article in Thieme ConnectPubMedGoogle Scholar
  • 12 Cohen LB, Hightower CD, Wood DA et al. Moderate level sedation during endoscopy: a prospective study using low-dose propofol, meperidine, fentanyl, and midazolam. Gastrointest Endosc 2004; 59: 795-803
    CrossrefPubMedGoogle Scholar
  • 13 Heuss LT, Froehlich F, Beglinger C. Changing patterns of sedation and monitoring practice during endoscopy: results of a nationwide survey in Switzerland. Endoscopy 2005; 37: 161-166
    Article in Thieme ConnectPubMedGoogle Scholar
  • 14 Vargo JJ, Holub JL, Faigel DO et al. Risk factors for cardiopulmonary events during propofol-mediated upper endoscopy and colonoscopy. Aliment Pharmacol Ther 2006; 24: 955-963
    CrossrefPubMedGoogle Scholar
  • 15 Koshy G, Nair S, Norkus E et al. Propofol versus midazolam and meperidine for conscious sedation in GI endoscopy. Am J Gastrenterol 2000; 95: 1476-1479
    CrossrefPubMedGoogle Scholar
  • 16 Yusoff IF, Raymond G, Sahai AV. Endoscopist administered propofol for upper-GI EUS is safe and effective: a prospective study in 500 patients. Gastrointest Endosc 2004; 60: 356-360
    CrossrefPubMedGoogle Scholar
  • 17 Sinnott J, Fricker E, Rogers A. Propofol, meperidine versus midazolam, meperidine: a one year comparison in a community based surgery center. Am J Gastroenterol 2004; 99: 303-S304
    PubMedGoogle Scholar
  • 18 Meah N, Parikh PB. Efficacy and safety of nurse-administered propofol as an adjunctive agent of conscious sedation in private non-academic gastroenterology practice setting. Am J Gastroenterol 2004; 99: S313
    PubMedGoogle Scholar
  • 19 Riphaus A, Stergiou N, Wehrmann T. Sedation with propofol for routine ERCP in high-risk octogenarians: a randomized, controlled study. Am J Gastroenterol 2005; 100: 1957-1963
    CrossrefPubMedGoogle Scholar
  • 20 Chen WX, Lin HJ, Zhang WF et al. Sedation and safety of propofol for therapeutic endoscopic retrograde cholangiopancreatography. Hepatobiliary Pancreat Dis Int 2005; 4: 437-440
    PubMedGoogle Scholar
  • 21 Tohda G, Higashi S, Wakahara S et al. Propofol sedation during endoscopic procedures: safe and effective administration by registered nurses supervised by endoscopists. Endoscopy 2006; 38: 360-367
    Article in Thieme ConnectPubMedGoogle Scholar
  • 22 Cohen LB, Dubovsky AN, Aisenberg J et al. Propofol for endoscopic sedation: a protocol for safe and effective administration by the gastroenterologist. Gastrointest Endosc 2003; 58: 725-732
    CrossrefPubMedGoogle Scholar
  • 23 Wehrmann T, Grotkamp J, Stergiou N et al. Electroencephalogram monitoring facilitates sedation with propofol for routine ERCP: a randomized, controlled trial. Gastrointest Endosc 2002; 56: 817-824
    CrossrefPubMedGoogle Scholar
  • 24 Wehrmann T, Kokabpick S, Lembcke B et al. Efficacy and safety of intravenous propofol sedation during routine ERCP: a prospective, controlled study. Gastrointest Endosc 1999; 49: 677-683
    CrossrefPubMedGoogle Scholar
  • 25 Carlsson U, Grattidge P. Sedation for upper gastrointestinal endoscopy: a comparative study of propofol and midazolam. Endoscopy 1995; 27: 240-243
    Article in Thieme ConnectPubMedGoogle Scholar
  • 26 Saenz-Lopez S, Rodriguez Munoz S, Rodriguez-Alcalde D et al. Endoscopist controlled administration of propofol: an effective and safe method of sedation in endoscopic procedures. Rev Esp Enferm Dig 2006; 98: 25-35
    PubMedGoogle Scholar
  • 27 Tohda G, Higashi S, Sakumoto H et al. Efficacy and safety of nurse-administered propofol sedation during emergency upper endoscopy for gastrointestinal bleeding: a prospective study. Endoscopy 2006; 38: 684-689
    Article in Thieme ConnectPubMedGoogle Scholar
  • 28 Barbi E, Petaros P, Badina L et al. Deep sedation with propofol for upper gastrointestinal endoscopy in children, administered by specially trained paediatricians: a prospective case series with emphasis on side effects. Endoscopy 2006; 38: 368-375
    Google Scholar
  • 29 Peter S, Wunderlich P, Beglinger C et al. Is nurse administered propofol sedation (NAPS) safe for endoscopies in a gastroenterologist ambulatory practice? [abstract]. Gastroenterology 2007; 132: A129
    PubMedGoogle Scholar
  • 30 Sipe BW, Scheidler M, Baluyut A et al. A prospective safety study of a low-dose propofol sedation protocol for colonoscopy. Clin Gastroenterol Hepatol 2007; 5: 563-566
    CrossrefPubMedGoogle Scholar
  • 31 Tagle M, Siu H, Ramos M. Propofol in combination with meperidine and midazolam in colonoscopy and upper endoscopy: first prospective study in private practice in Peru. Rev Gastroenterol Peru 2007; 27: 367-373
    PubMedGoogle Scholar
  • 32 Morse JW, Fowler SA, Morse AL. Endoscopist-administered propofol: a retrospective safety study. Can J Gastroenterol 2008; 22: 617-620
    PubMedGoogle Scholar
  • 33 Vargo JJ. Propofol: a gastroenterologist’s perspective. Gastrointest Endosc Clin North Am 2004; 14: 313-323
    CrossrefPubMedGoogle Scholar
  • 34 Sipe BW, Rex DK, Latinovich D et al. Propofol versus midazolam, meperidine for outpatient colonoscopy: administration by nurses supervised by endoscopists. Gastrointest Endosc 2002; 55: 815-825
    CrossrefPubMedGoogle Scholar
  • 35 Ulmer BJ, Hansen JJ, Overley CA et al. Propofol versus midazolam, fentanyl for outpatient colonoscopy: administration by nurses supervised by endoscopists. Clin Gastroenterol Hepatol 2003; 1: 425-432
    CrossrefPubMedGoogle Scholar
  • 36 Faulx AL, Vela S, Das A et al. A changing landscape of practice patterns regarding unsedated endoscopy and propofol use: a national survey [abstract]. Gastrointest Endosc 2004; 59: AB131
    PubMedGoogle Scholar
  • 37 Dewitt J, Leblanc J, McHenry L et al. Registered nurse-administered propofol sedation (RNAPS) versus midazolam and meperidine (MM) for endoscopic ultrasound (EUS): a prospective, randomized trial [abstract]. Gastrointest Endosc 2003; 57: AB78
    PubMedGoogle Scholar
  • 38 Byrne MF, Chiba N, Singh H et al. Propofol use for sedation during endoscopy in adults: a Canadian Association of Gastroenterology position statement. Can J Gastroenterol 2008; 22: 457-459
    PubMedGoogle Scholar
  • 39 American Society for Gastrointestinal Endoscopy. Training guideline for use of propofol in gastrointestinal endoscopy. Gastrointest Endosc 2004; 60: 167-172
    CrossrefPubMedGoogle Scholar
  • 40 Cohen LB, Delegge MH, Aisenberg J et al. AGA institute review of endoscopic sedation. Gastroenterology 2007; 19: 397-404
    PubMedGoogle Scholar
  • 41 Yongzi C, Xizhuo S et al. Mask adaptor - a novel method of positive pressure ventilation during propofol deep sedation for upper GI endoscopy. Gastrointestinal Endosc 2008; 68; 127-131
    PubMedGoogle Scholar
  • 42 Knape JT, Adriaensen H, van Aken H et al. Guidelines for sedation and/or analgesia by non-anaesthesiology doctors. Eur J Anaesthesiol 2007; 24: 563-567
    CrossrefPubMedGoogle Scholar
  • 43 Australian and New Zealand College of Anaesthetists Guidelines. http://www.anzca.edu.au/resources/professional-documents/pdfs/ps09-2014-guidelines-on-sedation-and-or-analgesia-for-diagnostic-and-interventional-medical-dental-or-surgical-procedures.pdf
    PubMedGoogle Scholar