Rex Douglas K, Overley Christine A, Walker John
Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
Rev Gastroenterol Disord. 2003 Spring;3(2):70-80.
Propofol for sedation during gastrointestinal endoscopic procedures has been associated with improved patient satisfaction relative to combinations of meperidine and midazolam. Delivery of propofol by registered nurses has been shown to be more cost-effective than administration by anesthesiologists or nurse anesthetists. Here, the authors review their experience with nurse-administered propofol sedation (NAPS) at their institutions (a hospital endoscopy unit in a tertiary medical center and an ambulatory surgery center). Endoscopic procedures for which NAPS is (or is not) recommended are listed, and a profile of patients for whom NAPS is contraindicated is given. Steps toward the development of programs and acquisition of training in NAPS are recommended; these include determining what state, local, and institutional laws apply to propofol administration; developing a written protocol; and instituting a training program that proceeds from observation to supervised administration to independent administration of propofol, with appropriate monitoring of safety records. Experience with NAPS using bolus titration (dosage, timing, coadministration with other agents) is detailed, and proper patient monitoring is discussed. NAPS is in its infancy, but this method of sedation shows considerable promise for improving patient satisfaction with, and thereby the reputation of, endoscopic procedures.
与哌替啶和咪达唑仑联合使用相比，丙泊酚用于胃肠内镜检查期间的镇静可提高患者满意度。已证明注册护士给予丙泊酚比麻醉医生或麻醉护士给药更具成本效益。在此，作者回顾了他们所在机构（一家三级医疗中心的医院内镜科室和一个门诊手术中心）采用护士给予丙泊酚镇静（NAPS）的经验。列出了推荐（或不推荐）使用NAPS的内镜检查程序，并给出了NAPS禁忌患者的概况。建议采取措施制定NAPS项目并开展培训；这些措施包括确定哪些州、地方和机构法律适用于丙泊酚给药；制定书面方案；并开展一个培训项目，从观察丙泊酚给药到监督给药再到独立给药，同时对安全记录进行适当监测。详细介绍了采用推注滴定法（剂量、时间、与其他药物联合使用）进行NAPS的经验，并讨论了对患者的正确监测。NAPS尚处于起步阶段，但这种镇静方法在提高患者对内镜检查的满意度以及内镜检查的声誉方面显示出相当大的前景。
