Endoscopist-Directed Propofol as an Adjunct to Standard Sedation: A Canadian Experience

Area of Science:

• Gastroenterology
• Anesthesiology
• Clinical Pharmacology

Background:

• Sedation practices for endoscopic procedures vary regionally.
• In Canada, fentanyl and midazolam are standard, with propofol used less frequently.
• This study evaluates propofol as an adjunct to standard sedation.

Purpose of the Study:

• To assess the safety and efficacy of non-anesthetist administered, low-dose propofol.
• Propofol was used as an adjunct to standard fentanyl and midazolam sedation.
• The study aimed to describe outcomes in patients undergoing endoscopic procedures.

Main Methods:

• A retrospective, single-center study of 4930 patients undergoing endoscopic procedures.
• Propofol sedation was administered intravenously by registered nurses under endoscopist direction.
• Data collected via chart review from a hospital endoscopy database (2004-2012).

Main Results:

• High success rates were observed across various procedures: 92.0% for colonoscopies, 99.0% for gastroscopies, 96.4% for flexible sigmoidoscopies, 94.0% for ERCP, and 91.7% for PEG insertion.
• Average doses: propofol 34.5 mg, fentanyl 94.3 mcg, midazolam 3.0 mg.
• 99.6% of patients experienced no adverse events; only one required sedation-related hospitalization, and there were no mortalities.

Conclusions:

• Low-dose propofol, as an adjunct to fentanyl and midazolam, is safe and effective.
• Nurse-administered propofol under endoscopist supervision is a viable sedation strategy.
• This approach supports successful endoscopic procedure completion with a high safety profile.