Korean J Gastroenterol.  2017 Jan;69(1):55-58. 10.4166/kjg.2017.69.1.55.

Safety of Non-anesthesiologist Administration of Propofol for Gastrointestinal Endoscopy

• Lee JK
• Jang DK
• Kim WH
• Kim JW
• Jang BI

• KMID: 2383431
• DOI: http://doi.org/10.4166/kjg.2017.69.1.55

Abstract

Propofol (2,6-diisopropylphenol) is a hypnotic drug with a very rapid onset and offset of action. It has increasingly been used in gastrointestinal endoscopy. Administration of propofol by nurses or endoscopists is commonly referred to as non-anesthesiologist-administered propofol (NAAP). There have been a lot of studies on the safety of NAAP compared with those by anesthesiologists. Safety results of those studies are summarized in this review.

Keyword

Propofol; Safety; Sedation; Gastrointestinal Endoscopy

MeSH Terms

Endoscopy, Gastrointestinal*
Propofol*
Propofol

Reference

References

1. Dumonceau JM, Riphaus A, Aparicio JR, et al. European Society of Gastrointestinal Endoscopy, European Society of Gastroenterology and Endoscopy Nurses and Associates, and the European Society of Anaesthesiology Guideline: Non-anesthesiologist administration of propofol for GI endoscopy. Endoscopy. 2010; 42:960–974.

2. Rex DK, Deenadayalu VP, Eid E, et al. Endoscopist-directed administration of propofol: a worldwide safety experience. Gastroenterology. 2009; 137:1229–1237. quiz 1518–1519.

3. Cohen LB, Wecsler JS, Gaetano JN, et al. Endoscopic sedation in the United States: results from a nationwide survey. Am J Gastroenterol. 2006; 101:967–974.

4. Vargo JJ, Zuccaro G Jr, Dumot JA, et al. Gastroenterologist-administered propofol versus meperidine and midazolam for advanced upper endoscopy: a prospective, randomized trial. Gastroenterology. 2002; 123:8–16.

5. Clarke AC, Chiragakis L, Hillman LC, Kaye GL. Sedation for endoscopy: the safe use of propofol by general practitioner sedationists. Med J Aust. 2002; 176:158–161.

6. Weston BR, Chadalawada V, Chalasani N, et al. Nurse-administered propofol versus midazolam and meperidine for upper endoscopy in cirrhotic patients. Am J Gastroenterol. 2003; 98:2440–2447.

7. Kulling D, Rothenbuhler R, Inauen W. Safety of nonanesthetist sedation with propofol for outpatient colonoscopy and esophagogastroduodenoscopy. Endoscopy. 2003; 35:679–682.

8. Dewitt J, McGreevy K, Sherman S, Imperiale TF. Nurse-administered propofol sedation compared with midazolam and meperidine for EUS: a prospective, randomized trial. Gastrointest Endosc. 2008; 68:499–509.

9. Horiuchi A, Nakayama Y, Hidaka N, Ichise Y, Kajiyama M, Tanaka N. Low-dose propofol sedation for diagnostic esophagogastroduodenoscopy: results in 10,662 adults. Am J Gastroenterol. 2009; 104:1650–1655.

10. Schilling D, Rosenbaum A, Schweizer S, Richter H, Rumstadt B. Sedation with propofol for interventional endoscopy by trained nurses in high-risk octogenarians: a prospective, randomized, controlled study. Endoscopy. 2009; 41:295–298.

11. Poincloux L, Laquiere A, Bazin JE, et al. A randomized controlled trial of endoscopist vs. anaesthetist-administered sedation for colonoscopy. Dig Liver Dis. 2011; 43:553–558.

12. Lucendo AJ, Olveira A, Friginal-Ruiz AB, et al. Nonanesthesiologist-administered propofol sedation for colonoscopy is safe and effective: a prospective Spanish study over 1000 consecutive exams. Eur J Gastroenterol Hepatol. 2012; 24:787–792.

13. de Paulo GA, Martins FP, Macedo EP, Goncalves ME, Mourao CA, Ferrari AP. Sedation in gastrointestinal endoscopy: a prospective study comparing nonanesthesiologist-administered propofol and monitored anesthesia care. Endosc Int Open. 2015; 3:E7–E13.

14. Goudra BG, Singh PM, Gouda G, et al. Safety of non-anesthesia provider-administered propofol (NAAP) sedation in advanced gastrointestinal endoscopic procedures: comparative metaanalysis of pooled results. Dig Dis Sci. 2015; 60:2612–2627.

15. Yamamoto H, Gotoda T, Nakamura T, et al. Clinical impact of gas-troenterologist-administered propofol during esophagogastroduodenoscopy: a randomized comparison at a single medical clinic. Gastric Cancer. 2015; 18:326–331.

16. Park HS, Han SY, Oh IH, et al. Comparative study of propofol plus fentanyl with midazolam for sedation during upper gastrointestinal endoscopy. Korean J Gastroenterol. 2001; 38:98–105.

17. Oh JH, Cho H, Kim YM, et al. Patient-controlled sedation versus nurse-administered sedation with propofol during colonoscopy. Korean J Gastrointest Endosc. 2005; 31:32–38.

18. Koo JS, Choi JH, Jung SW, et al. Conscious sedation with midazolam combined with propofol for colonoscopy. Korean J Gastrointest Endosc. 2007; 34:298–303.

19. Koo JS, Choi JH. Conscious sedation during gastrointestinal endoscopy: midazolam vs propofol. Korean J Gastrointest Endosc. 2011; 42:67–73.

20. Kim EH, Lee SK. Endoscopist-directed propofol: pros and cons. Clin Endosc. 2014; 47:129–134.

21. Suh SJ, Yim HJ, Yoon EL, et al. Is propofol safe when administered to cirrhotic patients during sedative endoscopy? Korean J Intern Med. 2014; 29:57–65.

22. Trapani G, Altomare C, Liso G, Sanna E, Biggio G. Propofol in anesthesia. Mechanism of action, structureactivity relationships, and drug delivery. Curr Med Chem. 2000; 7:249–271.

23. Jones GM, Doepker BA, Erdman MJ, Kimmons LA, Elijovich L. Predictors of severe hypotension in neurocritical care patients sedated with propofol. Neurocrit Care. 2014; 20:270–276.

24. Bryson HM, Fulton BR, Faulds D. Propofol. An update of its use in anaesthesia and conscious sedation. Drugs. 1995; 50:513–559.

25. Wernli KJ, Brenner AT, Rutter CM, Inadomi JM. Risks associated with anesthesia services during colonoscopy. Gastroenterology. 2016; 150:888–894. quiz e818.

26. Riphaus A, Geist C, Schrader K, Martchenko K, Wehrmann T. Intermittent manually controlled versus continuous infusion of propofol for deep sedation during interventional endoscopy: a prospective randomized trial. Scand J Gastroenterol. 2012; 47:1078–1085.

27. Hong GY, Seo KS, Park SW, Moon HC, Choi SC, Lim YK. The adequate dose of propofol for inducing sedation during performance of upper gastrointestinal endoscopy in Koreans. Korean J Gastrointest Endosc. 2009; 39:66–71.

28. Moon HC, Hong GY, Kim DJ, Choi SC, Park SW, Lim YK. The adequate induction dose of propofol for conscious sedation during esophagogastroduodenoscopy in persons 60 years or older. Korean J Gastrointest Endosc. 2010; 41:134–139.

29. Li Q, Zhou Q, Xiao W, Zhou H. Determination of the appropriate propofol infusion rate for outpatient upper gastrointestinal endoscopy-a randomized prospective study. BMC Gastroenterol. 2016; 16:49.

30. Fanti L, Gemma M, Agostoni M, et al. Target controlled infusion for non-anaesthesiologist propofol sedation during gastrointestinal endoscopy: The first double blind randomized controlled trial. Dig Liver Dis. 2015; 47:566–571.

31. Pambianco DJ, Whitten CJ, Moerman A, Struys MM, Martin JF. An assessment of computer-assisted personalized sedation: a sedation delivery system to administer propofol for gastrointestinal endoscopy. Gastrointest Endosc. 2008; 68:542–547.

32. Fanti L, Agostoni M, Arcidiacono PG, et al. Target-controlled infusion during monitored anesthesia care in patients undergoing EUS: propofol alone versus midazolam plus propofol. A prospective double-blind randomised controlled trial. Dig Liver Dis. 2007; 39:81–86.

33. Mazanikov M, Udd M, Kylanpaa L, et al. A randomized comparison of target-controlled propofol infusion and patient-controlled sedation during ERCP. Endoscopy. 2013; 45:915–919.

34. Mazanikov M, Udd M, Kylanpaa L, et al. Patient-controlled sedation with propofol and remifentanil for ERCP: a randomized, controlled study. Gastrointest Endosc. 2011; 73:260–266.

35. Paspatis GA, Manolaraki MM, Vardas E, Theodoropoulou A, Chlouverakis G. Deep sedation for endoscopic retrograde cholangiopancreatography: intravenous propofol alone versus intravenous propofol with oral midazolam premedication. Endoscopy. 2008; 40:308–313.

36. Ong WC, Santosh D, Lakhtakia S, Reddy DN. A randomized controlled trial on use of propofol alone versus propofol with midazolam, ketamine, and pentazocine "sedato-analgesic cocktail" for sedation during ERCP. Endoscopy. 2007; 39:807–812.

37. Oh JE, Lee HJ, Lee YH. Propofol versus Midazolam for Sedation during Esophagogastroduodenoscopy in Children. Clin Endosc. 2013; 46:368–372.

38. Ko KH, Hahm KB. Harmony of duet over solo: use of midazolam or propofol for sedative endoscopy in pediatric patients. Clin Endosc. 2013; 46:311–312.