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Sedation for endoscopy: the safe use of propofol by general practitioner sedationists
Author(s) -
Clarke Anthony C,
Chiragakis Louise,
Hillman Lybus C,
Kaye Graham L
Publication year - 2002
Publication title -
medical journal of australia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 131
eISSN - 1326-5377
pISSN - 0025-729X
DOI - 10.5694/j.1326-5377.2002.tb04345.x
Subject(s) - medicine , sedation , propofol , adverse effect , anesthesia , endoscopy , colonoscopy , airway , intubation , regimen , airway obstruction , emergency medicine , surgery , colorectal cancer , cancer
Objective: To determine the incidence of adverse events related to an endoscopy sedation regimen that included propofol, delivered by general practitioner (GP) sedationists. Design: Audit of reports of sedation‐related adverse events in patients undergoing endoscopy. A sample of 1000 patients' medical records was also reviewed to determine the drugs and dosages used and the proportion of sedations delivered by GPs. Setting and participants: All patients undergoing gastroscopy and/or colonoscopy from January 1996 to December 2000 in two private endoscopy centres in Canberra. Sedation was provided by GPs or a specialist anaesthetist, in most cases using a drug regimen that included propofol. Main outcome measures: Incidences of respiratory arrest, airway obstruction, hypoxia requiring intervention, hypotension, and death; number of interventions to correct these events, including extra airway management, bag‐mask ventilation, intravenous fluid infusion, endotracheal intubation and the use of reversal agents, and admission to hospital. Results: 28 472 procedures were performed in the five years. There were 185 sedation‐related adverse events (6.5/1000 procedures; 95% CI, 5.6–7.4): 107 for airway or ventilation problems (3.8/1000) and 77 hypotensive episodes (2.7/1000). Respiratory‐related adverse events were more common in patients managed by GPs than anaesthetists, but this was not significant ( P = 0.1). Interventions were recorded in 234 patients (8.2/1000; 95% CI, 7.2–9.3): 123 to maintain ventilation, and 111 intravenous infusions. GPs were more likely than anaesthetists to intervene to manage respiratory‐related adverse events ( P = 0.03). Four patients required transfer or admission to hospital. No patients required endotracheal intubation, and there were no deaths. Conclusions: The GP sedationists encountered a low incidence of adverse events, which they managed effectively. It appears that appropriately selected and trained GPs can safely use propofol for sedation during endoscopy.