Elsevier

Gastrointestinal Endoscopy

Volume 70, Issue 6, December 2009, Pages 1053-1059
Gastrointestinal Endoscopy

Position statement
Position statement: nonanesthesiologist administration of propofol for GI endoscopy

https://doi.org/10.1016/j.gie.2009.07.020Get rights and content

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Background

Propofol (2,6 diisopropyl phenol) is an ultra-short–acting sedative agent with no analgesic properties, which provides sedative and amnestic effects.1 Approved by the Food and Drug Administration for the induction and maintenance of anesthesia, propofol's product label indicates that it “should be administered only by persons trained in the administration of general anesthesia.” Since its introduction in the 1980s, however, its clinical applications have expanded to include monitored anesthesia

Safety of nonanesthesiologist-administered propofol for GI endoscopy

A systematic review of the published articles and abstracts in which propofol was administered by nonanesthesiologists for endoscopic procedures was performed. The methodology for the inclusion of published literature is outlined in Appendix 1. Forty-six articles were identified initially.2, 3, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49 Eighteen articles7, 8, 9, 10, 11, 12

Efficacy of nonanesthesiologist-administered propofol for GI endoscopy

For patients undergoing EGD and colonoscopy, the average time to sedation induction is shorter for propofol than for benzodiazepines. There is no difference in procedure times among colonoscopy patients receiving propofol alone or midazolam plus a narcotic. The average recovery time after colonoscopy was shorter in patients receiving propofol alone (15.6 min) or propofol plus a narcotic (14.3 min) than for patients receiving a combination of benzodiazepine and a narcotic (54.9 min).55, 66

Economics of nonanesthesiologist-administered propofol for GI endoscopy

There are limited data comparing the cost-effectiveness of NAAP to that of standard sedation or anesthesiologist-mediated sedation. A cost-effectiveness analysis comparing gastroenterologist-administered propofol to standard sedation in patients undergoing ERCP or EUS found that propofol administered by a trained registered nurse was the dominant strategy in spite of the additional costs that are associated with its use.24 In another study, the total procedural costs (recovery and medications)

Training guidelines for nonanesthesiologist-administered propofol for GI endoscopy

Although training guidelines for procedural sedation exist, the optimal educational experience to facilitate the acquisition of knowledge and the development of appropriate skill sets remain uncertain.68, 69, 70 Experts agree, however, that specialized training is required of individuals planning to administer propofol. There is evidence, based upon the experience with advanced cardiac life support training and several small-scale studies, that a multifaceted interdisciplinary program is a more

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  • Cited by (0)

    This article is being published jointly in Gastrointestinal Endoscopy, American Journal of Gastroenterology, Gastroenterology, and Hepatology.

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