Walker John A, McIntyre Robert D, Schleinitz Paul F, Jacobson Kris N, Haulk Anthony A, Adesman Peter, Tolleson Shelley, Parent Robyn, Donnelly Rosie, Rex Douglas K
Department of Anesthesiology, Surgery Center Of Southern Oregon, Medford, Oregon 97504, USA.
Am J Gastroenterol. 2003 Aug;98(8):1744-50. doi: 10.1111/j.1572-0241.2003.07605.x.
Narcotics and benzodiazepines are commonly used for sedation for endoscopy in the United States. Propofol has certain advantages over narcotics and benzodiazepines, but its use is often controlled by anesthesia specialists. This report describes our experience with dosage, safety, patient satisfaction, and discharge time with nurse-administered propofol sedation in 9152 endoscopic cases. The study was performed in a private practice ambulatory surgery center in Medford, Oregon. With the assistance of an anesthesiologist, we developed a protocol for administration of propofol in routine endoscopic cases, in which propofol was given by registered nurses under the supervision of endoscopists or gastroenterologists. We then applied the protocol with 9152 patients. There were seven cases of respiratory compromise (three prolonged apnea, three laryngospasm, one aspiration requiring hospitalization), all associated with upper endoscopy. Five patients required mask ventilation, but none required endotracheal intubation. There were seven colonic perforations (<1 per 1000 colonoscopies), of which three may have involved forceful sigmoid disruption. Of patients who had previously received narcotic or benzodiazepine sedation, 84% preferred propofol. Gastroenterologists strongly preferred propofol. The mean time from completion of procedures to discharge in a sample of 100 patients was 18 min.Nurse-administered propofol sedation in an ambulatory surgery center was safe and resulted in high levels of patient satisfaction and rapid postprocedure recovery and discharge.
在美国，麻醉药和苯二氮䓬类药物常用于内镜检查的镇静。丙泊酚相对于麻醉药和苯二氮䓬类药物具有某些优势，但其使用通常由麻醉专科医生控制。本报告描述了我们在9152例内镜检查病例中使用护士给予丙泊酚镇静的剂量、安全性、患者满意度及出院时间方面的经验。该研究在俄勒冈州梅德福的一家私立门诊手术中心进行。在一名麻醉医生的协助下，我们制定了常规内镜检查病例中丙泊酚的给药方案，其中丙泊酚由注册护士在内镜医师或胃肠病学家的监督下给予。然后我们将该方案应用于9152例患者。有7例呼吸功能不全（3例长时间呼吸暂停、3例喉痉挛、1例需要住院治疗的误吸），均与上消化道内镜检查有关。5例患者需要面罩通气，但无一例需要气管插管。有7例结肠穿孔（每1000例结肠镜检查中<1例），其中3例可能涉及乙状结肠强力破裂。在之前接受过麻醉药或苯二氮䓬类药物镇静的患者中，84%更喜欢丙泊酚。胃肠病学家强烈倾向于使用丙泊酚。在100例患者的样本中，从检查结束到出院的平均时间为18分钟。在门诊手术中心由护士给予丙泊酚镇静是安全的，并且导致患者满意度高、术后恢复快及出院迅速。
