Balanced Propofol Sedation in Patients Undergoing EUS-FNA: A Pilot Study to Assess Feasibility and Safety

N Pagano, M Arosio, F Romeo, G Rando, G Del Conte, A Carlino, G Strangio, E Vitetta, A Malesci, A Repici, N Pagano, M Arosio, F Romeo, G Rando, G Del Conte, A Carlino, G Strangio, E Vitetta, A Malesci, A Repici

Abstract

Introduction and aims. Balanced propofol sedation (BPS) administered by gastroenterologists has gained popularity in endoscopic procedures. Few studies exist about the safety of this approach during endosonography with fine needle aspiration (EUS-FNA). We assessed the safety of BPS in EUS-FNA. Materials and methods. 112 consecutive patients, referred to our unit to perform EUS-FNA, from February 2008 to December 2009, were sedated with BPS. A second gastroenterologist administered the drugs and monitorized the patient. Results. All the 112 patients (62 males, mean age 58.35) completed the examination. The mean dose of midazolam and propofol was, respectively, of 2.1 mg (range 1-4 mg) and 350 mg (range 180-400). All patients received oxygen with a mean flux of 4 liter/minute (range 2-6 liters/minute). The mean recovery time after procedure was 25 minutes (range 18-45 minutes). No major complications related to sedation were registered during all procedures. The oxygen saturation of all patients never reduced to less than 85%. Blood systolic pressure during and after the procedure never reduced to less than 100 mmHg. Conclusions. In our experience BPS administered by non-anaesthesiologists provided safe and successful sedation in patients undergoing EUS-FNA.

References

    1. Alkire MT, Haier RJ. Correlating in vivo anaesthetic effects with ex vivo receptor density data supports a GABAergic mechanism of action for propofol, but not for isoflurane. British Journal of Anaesthesia. 2001;86(5):618–626.
    1. Vargo JJ, Cohen LB, Rex DK, Kwo PY. American Association for the Study of Liver Diseases; American College of Gastroenterology; American Gastroenterological Association; American Society fo Gastrointestinal Endoscopy. Gastroenterology. 2009;137(6):2161–2167.
    1. Vargo JJ, Zuccaro G, Jr., Dumot JA, Shay SS, Conwell DL, Morrow JB. Gastroenterologist-administered propofol for therapeutic upper endoscopy with graphic assessment of respiratory activity: a case series. Gastrointestinal Endoscopy. 2000;52(2):250–255.
    1. Külling D, Rothenbühler R, Inauen W. Safety of nonanesthetist sedation with propofol for outpatient colonoscopy and esophagogastroduodenoscopy. Endoscopy. 2003;35(8):679–682.
    1. Jung M, Hofmann C, Kiesslich R, Brackertz A. Improved sedation in diagnostic and therapeutic ERCP: propofol is an alternative to midazolam. Endoscopy. 2000;32(3):233–238.
    1. VanNatta ME, Douglas KRex. Propofol alone titrated to deep sedation versus propofol in combination with opioids and/or benzodiazepines and titrated to moderate sedation for colonoscopy. The American Journal of Gastroenterol. 2006;101(10):2209–2217.
    1. Waring JP, Baron TH, Hirota WK, et al. Guidelines for conscious sedation and monitoring during gastrointestinal endoscopy. Gastrointestinal Endoscopy. 2003;58:317–322.
    1. American Society of Anesthesiologists Task Force on Sedation and Analgesia by N-A. Practice guidelines for sedation and analgesia by non-anesthesiologists. Anesthesiology. 2002;96:1004–1017.
    1. Qadeer MA, Vargo JJ, Khandwala F, Lopez R, Zuccaro G. Propofol versus traditional sedative agents for gastrointestinal endoscopy: a meta-analysis. Clinical Gastroenterology and Hepatology. 2005;3(11):1049–1056.
    1. Fanti L, Agostoni M, Casati A, et al. Target-controlled propofol infusion during monitored anesthesia in patients undergoing ERCP. Gastrointestinal Endoscopy. 2004;60(3):361–366.
    1. Hansen JJ, Ulmer BJ, Rex DK. Technical performance of colonoscopy in patients sedated with nurse-administered propofol. American Journal of Gastroenterology. 2004;99(1):52–56.
    1. Cohen LB, Hightower CD, Wood DA, Miller KM, Aisenberg J. Moderate level sedation during endoscopy: a prospective study using low-dose propofol, meperidine/fentanyl, and midazolam. Gastrointestinal Endoscopy. 2004;59(7):795–803.
    1. Cordruwisch W, Doroschko M, Wurbs D, et al. Deep sedation in gastrointestinal endoscopic interventions: safety and reliability of a combination of midazolam and propofol. Deutsche Medizinische Wochenschrift. 2000;125:619–622.
    1. Seifert H, Schmitt TH, Gültekin T, Caspary WF, Wehrmann T. Sedation with propofol plus midazolam versus propofol alone for interventional endoscopic procedures: a prospective, randomized study. Alimentary Pharmacology and Therapeutics. 2000;14(9):1207–1214.
    1. Fanti L, Agostoni M, Arcidiacono PG, et al. Target-controlled infusion during monitored anestesia care in patients undergoing EUS: propofol alone versus midazolam plus propofol. A prespective double-blind randomised controlled trial. Digestive and Lived Disease. 2007;39:81–86.
    1. Krugliak P, Ziff B, Rusabrov Y, Rosenthal A, Fich A, Gurman GM. Propofol versus midazolam for conscious sedation guided by processed EEG during endoscopic retrograde cholangiopancreatography: a prospective, randomized, double-blind study. Endoscopy. 2000;32(9):677–682.
    1. Gillham MJ, Hutchinson RC, Carter R, Kenny GNC. Patient-maintained sedation for ERCP with a target-controlled infusion of propofol: a pilot study. Gastrointestinal Endoscopy. 2001;54(1):14–17.
    1. Vargo JJ, Zuccaro G, Jr., Dumot JA, et al. Gastroenterologist-administered propofol versus meperidine and midazolam for advanced upper endoscopy: a prospective, randomized trial. Gastroenterology. 2002;123(1):8–16.
    1. Yusoff IF, Raymond G, Sahai AV. Endoscopist administered propofol for upper-GI EUS is safe and effective: a prospective study in 500 patients. Gastrointestinal Endoscopy. 2004;60(3):356–360.
    1. DeWitt J, McGreevy K, Sherman S, Imperiale TF. Nurse-administered propofol sedation compared with midazolam and meperidine for EUS: a prospective, randomized trial. Gastrointestinal Endoscopy. 2008;68(3):499–509.
    1. Fatima H, Dewitt J, Leblanc J, Sherman S, McGreevy K, Imperiale TF. Nurse-administered propofol sedation for upper endoscopic ultrasonography. American Journal of Gastroenterology. 2008;103(7):1649–1656.
    1. Vargo JJ. Procedural sedation. Current Opinion in Gastroenterology. 2010;26(5):421–424.
    1. Suits J, Frazee R, Erickson RA. Endoscopic ultrasound and fine needle aspiration for the evaluation of pancreatic masses. Archives of Surgery. 1999;134(6):639–643.
    1. Wehrmann T, Kokabpick S, Lembcke B, Caspary WF, Seifert H. Efficacy and safety of intravenous propofol sedation during routine ERCP: a prospective, controlled study. Gastrointestinal Endoscopy. 1999;49(6):677–683.
    1. Nayar DS, Guthrie WG, Goodman A, et al. Comparison of propofol deep sedation versus moderate sedation during endosonography. Digestive Diseases and Sciences. 2010;55(9):2537–2544.
    1. Schilling D, Rosenbaum A, Schweizer S, Richter H, Rumstadt B. Sedation with propofol for interventional endoscopy by trained nurses in high-risk octogenarians: a prospective, randomized, controlled study. Endoscopy. 2009;41(4):295–298.
    1. Klein SM, Hauser GJ, Anderson BD, et al. Conparison of intermittent versus continuous infusion of propofol for elective oncology procedures in children. Pediatric Critical Care Medicine. 2003;4(1):78–82.

Source: PubMed

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