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Establishing an anaesthetist-delivered propofol sedation service for advanced endoscopic procedures: implementing the RCA/BSG guidelines
  1. Ian Smith1,
  2. Damien Durkin2,
  3. Kaw Wai Lau3,
  4. Srisha Hebbar3
  1. 1Directorate of Anaesthesia, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, Staffordshire, UK
  2. 2Surgery, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, Staffordshire, UK
  3. 3Gastroenterology, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, Staffordshire, UK
  1. Correspondence to Dr Ian Smith, Directorate of Anaesthesia, University Hospitals of North Midlands, Royal Stoke University Hospital, Stoke-on-Trent, ST4 6QG Staffordshire, UK; damsmith{at}btinternet.com

Abstract

Background Following recommendations from the Royal College of Anaesthetists and the British Society of Gastroenterology, we report our results of propofol sedation for complex endoscopic procedures delivered by a single consultant anaesthetist over a 5-year period.

Methods A weekly session was provided in the endoscopy department for procedures that were complex or could previously not be completed successfully. Deep sedation was provided by intermittent propofol bolus doses, supplemented with fentanyl where necessary, titrated to clinical effect. Patients were usually in semiprone or lateral positions and spontaneously breathed air supplemented with nasal oxygen. Service evaluation included patient recall, endoscopist satisfaction with conditions, procedural success and airway-related adverse outcomes.

Results We completed 1000 procedures, 42.5% of which were endoscopic retrograde cholangiopancreatography, with the remainder comprising a diverse range of endoscopic procedures of 3–156 min duration. Procedural conditions were excellent in 79% of cases, 261 procedures were completed which had been previously abandoned, 246 patients (24.6%) had a better experience than previously and none recalled any part of their procedure. Three patients required transient bag and mask ventilation, and nasal airways were used in 12 patients, but none required tracheal intubation or vasopressor support.

Conclusions These guidelines facilitated a propofol sedation service with considerable benefits for patients and endoscopists. Provision of deep propofol sedation by an anaesthetist, in patients with an unsecured airway, appears practical, effective and efficient. Small adjustments to the airway were fairly common, but the incidence of adverse events and requirement for airway instrumentation was low.

  • endoscopic procedures

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Footnotes

  • Contributors IS delivered propofol sedation to all patients, collected data and wrote the first draft of the manuscript and its revisions. DD, KWL and SH performed 284, 224 and 96 of the cases reported, respectively, and all contributed to service development and evaluation and manuscript preparation.

  • Competing interests None declared.

  • Ethics approval As this constituted a service development, we did not seek ethics committee approval or individual patient consent to collect anonymised data from routine clinical records and a personal anaesthetic logbook.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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