Non-anesthesiologist-administered propofol sedation for gastrointestinal endoscopy in ASA III patients: Eight-year...

Sedation in gastrointestinal endoscopy is widely recognized for improving patient comfort, procedure quality, and endoscopist satisfaction. Although non-anesthesiologist-administered sedation (NAS) with propofol is well established for low-risk patients (i.e. American Society of Anesthesiologist [ASA] I-II), evidence for its safety in higher-risk populations remains limited. The aim of this study was to evaluate safety of NAS with propofol in ASA III patients undergoing diagnostic gastrointestinal endoscopy.

This observational study included ASA III patients who underwent elective gastroscopy or colonoscopy under NAS with propofol, with or without adjunctive midazolam and/or fentanyl, between 2017 and 2024. Sedation was administered by trained endoscopy personnel according to European Society of Gastrointestinal Endoscopy/European Society of Gastroenterology and Endoscopy Nurses and Associates guidelines. Anesthesia-related adverse events (ARAEs) were categorized as minor, moderate, or severe based on World Society of Intravenous Anesthesia definitions. Secondary outcomes included identification of potential risk factors for ARAEs.

Among 1423 procedures (43.4% gastroscopies, 56.6% colonoscopies), overall incidence of ARAEs was 5.2% (3.9% minor, 0.9% moderate, 0.4% severe), with no tracheal intubations or deaths. Hypotension (3.6%) was the most frequent and all such events were transient and reversible. Severe ARAEs were all bradycardia, successfully treated with atropine administration. The ARAE rate was higher with propofol + midazolam (8.6%) than with propofol + fentanyl (3.7%, P = 0.04). Logistic regression analysis identified lower body mass index as the only independent predictor of ARAEs ( P < 0.001).

NAS with propofol appears safe and feasible in ASA III patients when performed by trained staff following standardized protocols and monitoring. These findings support expanding NAS with propofol to higher-risk populations, optimizing resources and access to endoscopic care.