Nurse administered propofol sedation for pulmonary endoscopies requires a specific protocol

Dan Med J. 2012 Aug;59(8):A4467.

Abstract

Introduction: This study provides an evaluation and risk analysis of propofol sedation for endoscopic pulmonary procedures according to our unit's "gastroenterologic nurse-administered propofol sedation (NAPS) guideline".

Material and methods: The present study is a prospective descriptive study performed at the Endoscopy Unit, Gentofte Hospital, Copenhagen, from May to July 2009. The study comprised at total of 51 consecutive patients who underwent 77 endoscopic procedures. Only patients above the age of 16 years were eligible for treatment. The exclusion criteria were as follows: American Society of Anesthesiologists (ASA) class > 3, history of sedation-related complications, severe chronic obstructive pulmonary disease. Excluded were patients with a potentially difficult airway and ventricular retention. Data on the number and type of procedure, baseline characteristics, sedation time, propofol dose administered and adverse events were obtained from medical histories.

Results: A total of 23 cases of adverse events were recorded, including one event of hypotension and 22 events of hypoxaemia. Five patients needed assisted ventilation. The frequency of hypoxaemia in sessions involving bronchoscopy was 17 of 26 (65%) compared with transoesophageal endoscopic ultrasound (EUS) (17 of 45, 35%) and endoscopic bronchial ultrasound (EBUS) (three of six, 50%). Endoscopist assessment of working conditions was good and patient assessment of discomfort was low. No patients required endotracheal intubation and there was no mortality.

Conclusion: This study supports the conclusion that propofol administered by nurses provides for good working conditions and satisfied patients. But our "NAPS for endoscopic gastroenterologic procedures" guideline was unsuited for endoscopic pulmonary procedures including EUS.

Funding: This work was supported by the START research foundation at Gentofte Hospital.

Trial registration: not relevant.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Attitude of Health Personnel
  • Bronchoscopy / adverse effects
  • Bronchoscopy / nursing*
  • Deep Sedation / adverse effects
  • Deep Sedation / nursing*
  • Endosonography / adverse effects
  • Endosonography / nursing*
  • Humans
  • Hypertension / etiology
  • Hypnotics and Sedatives / administration & dosage*
  • Hypnotics and Sedatives / adverse effects
  • Hypoxia / etiology
  • Middle Aged
  • Nurse's Role
  • Patient Satisfaction
  • Pilot Projects
  • Practice Guidelines as Topic*
  • Propofol / administration & dosage*
  • Propofol / adverse effects
  • Prospective Studies
  • Risk Assessment

Substances

  • Hypnotics and Sedatives
  • Propofol