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Nurse-Administered Propofol Sedation for Upper Endoscopic Ultrasonography

Fatima, Hala, M.D.1; DeWitt, John, M.D.1; LeBlanc, Julia, M.D.1; Sherman, Stuart, M.D.1; McGreevy, Kathleen, R.N.1; Imperiale, Thomas F., M.D.1,2

American Journal of Gastroenterology: July 2008 - Volume 103 - Issue 7 - p 1649–1656
ORIGINAL CONTRIBUTION: ENDOSCOPY
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BACKGROUND Limited data exist regarding the safety of nurse-administered propofol sedation (NAPS) for advanced endoscopy.

AIMS To evaluate the frequency of and the risk factors for complications associated with NAPS for upper endoscopic ultrasound (EUS).

METHODS Consecutive upper EUS examinations using NAPS were retrospectively identified. Clinical data and adverse events were recorded. Univariate and multivariable repeated measures logistic regression models were used to identify independent risk factors for complications.

RESULTS Among 806 EUS procedures, the mean procedure duration, time for sedation induction, and postprocedure recovery time were: 34 ± 20 min, 3.6 ± 1.4 min, and 27 ± 23 min, respectively. A decline in systolic blood pressure (SBP) to <90 mm Hg occurred in 104 patients (13%). Six patients (0.7%) had a decline in oxygen saturation (SpO2) to <90%. Four patients (0.5%; 95% confidence interval [CI] 0.14–1.27) required assisted positive pressure ventilation. There were no major complications. The minor complication rate from sedation was 21% (95% CI 17.2–25.3). All of the complications were clinically insignificant. Overall complication risk was not related to age, dose, or procedure time. Sedation-related complication rates for advanced experience-level (≥100 NAPS procedures) nurses were lower compared to the least-experienced (≤30 NAPS procedures) nurses (17.2%vs 25.4%, odds ratio [OR] 0.61, 95% CI 0.41–0.92).

CONCLUSIONS NAPS for upper EUS is safe and may be performed without major complications. Four patients (0.5%) required assisted ventilation. Minor complications occurred in 21% of patients, but were not associated with patient age, propofol dose, or procedure time.

1Division of Gastroenterology, Department of Medicine, Indiana University Medical Center; 2The Regenstrief Institute, Inc., Indianapolis, Indiana

Reprint requests and correspondence: John M. DeWitt, M.D., Division of Gastroenterology, Department of Medicine, Indiana University Medical Center, 550 N University Boulevard., UH 4100, Indianapolis, IN 46202-5121.

CONFLICT OF INTEREST

Guarantor of the article: Hala Fatima, M.D.

Specific author contributions: Hala Fatima, John DeWitt, and Thomas F. Imperiale: planning, conducting, and drafting the manuscript; and Julia LeBlanc, Stuart Sherman, and Kathleen McGreevy: planning the manuscript. All the authors approved the final draft submitted.

Financial support: The study is supported in part by National Institutes of Health grant K24 DK 02756 (Dr. Imperiale). The funding source had no role in the study design, in the collection analysis and interpretation of data, or in the writing of the report. John DeWitt received grants from Cook Endoscopy, Astra Zeneca.

Potential competing interests: John DeWitt is a consultant for Olympus, Inc.

The study was performed at the Division of Gastroenterology, Indiana University Hospital.

Received June 14, 2007; accepted February 13, 2008.

© The American College of Gastroenterology 2008. All Rights Reserved.
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