Safety of propofol sedation administered by gastroenterologists in digestive endoscopy

Abstract

Aim: Traditionally, sedation with propofol has been approved exclusively for use by anethesiologists, however, an extensive amount of published information has shown that sedation with propofol administered by non-anesthesiologists is safe and effective. The present study was conducted with the objective of evaluating the safety in the administration of propofol by gastroenterologists for the performance of procedures in digestive endoscopy
Methods: A retrospective study was conducted in which the records of 1135 patients who underwent digestive and therapeutic digestive endoscopies were reviewed in the period between January 2016 and March 2017. The patients were classified by age, gender, risk classification of the American Society of Anesthesiologists (ASA), indication for endoscopy, and dose of propofol. The adverse effects associated with the use of propofol were recorded, such as episodes of transient hypoxemia, serious cardiopulmonary complications and death.
Results: We included data from 1135 patients (56% were women) who underwent gastrointestinal endoscopy under sedation with propofol administered by gastroenterologist in a period of 14 months. The average dose used for propofol was 154 +/- 66 mg of propofol. According to the American Society of Anesthesiologists risk classification, 84% of the patients correspond to risk I and II, 14.8% to risk level III and 1.1% to risk level IV. The study carried out the most were gastroscopies (52.6%) and according to the indication, 79.6% corresponded to diagnostic studies, followed by 12.1% for upper gastrointestinal bleeding. Regarding the documented complications, 70 episodes of hypoxemia were identified, corresponding to 6.2% of the sedations performed. (95% CI, 4.7-7.6). Only 3.7% of patients had an episode of hypoxemia below 80%. All episodes of hypoxemia, except one, resolved with simple maneuvers such as chin elevation. There were no serious cardiopulmonary complications or deaths during the study. We identified as risk factors for the appearance of hypoxemia a risk classification of the American Society of Anesthesiologists greater than 3 and performance of the endoscopic study for esophageal dilation or percutaneous gastrostomy placement.
Conclusions: The use of sedation with propofol administered by non-anesthesiologists in the present study did not show an increase in the appearance of serious cardiopulmonary complications, or in episodes of hypoxemia.