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| |  Adverse Events Rate is Low When Propofol is Administered By Trained Professional BETHESDA, Md -- March 5, 2010 -- Propofol is safe for advanced endoscopic procedures with a low rate of sedation-related adverse events when administered by a trained professional, according to a study published in Clinical Gastroenterology and Hepatology. “This is the first paper to report the frequency of airway modifications (AMs) associated with propofol use in endoscopy,” said lead author Sreenivasa S. Jonnalagadda, MD, Washington University School of Medicine, St. Louis, Missouri. “We believe that the need to perform AMs highlights the importance of a trained professional, such as a nurse anaesthetist, who is solely responsible for maintenance of sedation and patient monitoring while using propofol,” he said. “Perhaps the highest-risk patients should be managed by nurse anesthetists trained in advanced airway interventions, whereas lower-risk patients can be safely managed by professionals with less intensive airway training.” Dr. Jonnalagadda and colleagues prospectively studied 799 patients undergoing sedation with propofol for advanced endoscopic procedures, including endoscopic retrograde cholangiopancreatography, endoscopic ultrasound, and small bowel enteroscopy. Sedative dosing was determined by a certified registered nurse anaesthetist with a goal of achieving deep sedation. Sedation-related complications included 154 AMs performed in 115 patients, such as 97 chin lifts, 29 modified face mask ventilations, and 28 nasal airways. Additional complications included hypoxemia (12.8%); hypotension requiring vaso-pressors (0.5%); and early procedure termination (0.6%); these rates are comparable with other published data. Elevated BMI, male sex, and American Society of Anesthesiologist class >=3 were found to be independent predictors of patients who would be at the highest risk for needing AMs. “Future studies are likely to identify additional clinical predictors, which may impact the choice of sedatives and level of airway training required to safely administer propofol,” added Dr. Jonnalagadda. “While propofol is undoubtedly an attractive sedative for endoscopic procedures, there continues to be debate regarding its safe use by non-anesthesiologists. Newer technologies such as computer-assisted personalised sedation are likely to standardise the use of propofol by non-anaesthesiologists in endoscopy.”
The AGA Institute believes that the administration of propofol by non-anaesthesiologists is safe and that proper training and patient selection are crucial, as outlined in the “Position Statement: Non-Anesthesiologist Administration of Propofol for GI Endoscopy” issued by the 4 major gastroenterology and hepatology societies and published in the December 2009 issue of Gastroenterology.
SOURCE: American Gastroenterological Association
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