Abstracts and Programme: EUROANAESTHESIA 2011: The European Anaesthesiology Congress: Evidence-based Practice and Quality Improvement
Experience of an interdisciplinary anaesthesiology and nursing team in a gastrointestinal endoscopy unit
Introduction and Aim: Demand of sedation and monitored anaesthesia care has dramatically increased in recent years in gastrointestinal endoscopy (GIE) units. Anaesthesia professional-delivered sedation has important economical implications and departments of Anaesthesia have limited resources becoming frequently saturated. Since then, to develop new anaesthesia provider models may be mandatory. In the present study we describe the experience in the GIE Unit of our institution where we have consolidated a new model of an anaesthesia care team.
Methods: This descriptive study analysed the activity performed by a team of anaesthesiologists and nurse anaesthetists over a 1 year period (2009) in a digestive endoscopy unit. Anaesthesia technique was performed by the registered nurse under the supervision and responsibility of the anaesthesiologist who was involved in 2 or 3 procedures simultaneously (1anaesthesiologist: 2nurses + 1anaesthesiologist: 3nurses, 5 procedures at the same time). All procedures were performed under deep sedation with continuous intravenous perfusion of remifentanil and propofol (target-controlled infusion system) following the standard protocol of the unit. Monitoring included: EKG, non invasive arterial pressure, pulse oximetry and respiratory rate by impedance. The day before to the procedure, telephonic preanaesthesia assessment was performed in all patients.
Results: A total of 5805 endoscopic procedures were performed under sedation in 5432 patients (2879 F[53%]/ 2553 M[47%], 59±16 yrs.[range 18-96]. Twenty-four per cent of patients were ASA III or IV class. Both, simple (upper GIE and colonoscopies, 73%) and advanced endoscopic procedures (endoscopy ultrasound, endoscopic retrograde cholangiopancreatography, and others, 27%) were included. Anaesthesia-related mortality did not occur. None of the patients required neither endotracheal intubation nor any resuscitation maneuver. The most common complication was mild respiratory depression requiring jaw thrust maneuver or insertion of oropharyngeal airway (4.8%). Mask ventilation was necessary in 12 patients (0.14%). Five patients (0.08%) showed hypotension or bradycardia that required pharmacological treatment. In 5 patients (0.08%) the procedure had to be finished early due to oversedation.
Conclusion: Deep sedation by an anaesthesia care team with anaesthesiologists and nurse anaesthetists is clinically safe and efficacious for all patients undergoing endoscopic procedures.© 2011 European Society of Anaesthesiology