It's just as safe for endoscopists to administer propofol sedation during endoscopies as it is for them to administer opioids or benzodiazepines or for anesthesiologists to administer general anesthesia, according to a study published in the journal Gastroenterology.
Indiana University Medical Center's Douglas K. Rex, MD, and colleagues, examined 223,656 published and 422,424 unpublished cases of endoscopist-directed propfol sedation (EDP) and found 11 cases that resulted in endotracheal intubation. Four of those patients died, and the other 7 patients fully recovered with no permanent neurologic injuries. The authors note that the 4 patients who died all had "ASA III or higher status" and "were undergoing nonroutine medical procedures."
The results showed that the risk of complications was higher when EDP was used for upper endoscopic procedures than during colonoscopy. None of the reported deaths occurred during colonoscopy.
Based on these findings, the authors estimate that it would cost about $5.3 million per life-year saved to substitute anesthesia personnel for the endoscopists who performed propofol sedation in the cases studied.
"It is reasonable for health care planners to doubt the wisdom of spending scarce resources on anesthesiologists to assist in endoscopic procedures, particularly those in low-risk patients," write the authors. They say their research supports "the endorsement of propofol use for endoscopy by trained nonanesthesiologists."
Two of the study authors disclosed relationships with pharmaceutical companies and one — John A. Walker, MD — is the CEO of Dr. NAPS, an organization that advocates nurse administered propofol sedation for gastroenterological endoscopy. Dr. Rex, the lead author, disclosed no conflicts of interest.
Irene Tsikitas
