Heuss Ludwig T, Schnieper Patrizia, Drewe Juergen, Pflimlin Eric, Beglinger Christoph
Department of Gastroenterology, University Hospital Basel, Basel, Switzerland.
Am J Gastroenterol. 2003 Aug;98(8):1751-7. doi: 10.1111/j.1572-0241.2003.07596.x.
Propofol, a rapidly-acting hypnotic agent, is increasingly being used for endoscopic sedation. Serious adverse effects, including respiratory and cardiovascular depression, make many endoscopists reluctant to use propofol in critically ill patients. This study characterizes propofol's safety profile in consecutive high-risk patients (American Society of Anesthesiologists [ASA] classes III and IV) compared with matched subjects (ASA classes I and II).
During a 19-month period, 1370 at risk-patients were sedated with propofol, of whom 47% (614 ASA III, 28 ASA IV) were age matched with 642 consecutive patients of the same gender and age assigned to ASA classes I and II and undergoing the same endoscopic procedures (395 gastroscopies, 201 colonoscopies, 14 combined). Registered nurses performed all sedations by propofol dose titration while carefully monitoring arterial oxygen saturation, heart rate, and blood pressure.
No major complications occurred among the critically ill patients. There was, however, an increased risk for a short relevant oxygen desaturation (<90%) of 3.6% for ASA III and IV versus 1.7% for ASA I and II (p = 0.036). In four versus one case, short mask ventilation was necessary. Also, a greater proportion of patients showed a > or =5% oxygen saturation decrease. There was no pronounced influence on arterial pressure or heart rate and no perforations in 336 colonoscopies.
With careful monitoring, propofol sedation during GI endoscopies is safe, even for high-risk patients. Considering their higher comorbidity and tendency toward oxygen desaturation, they need particularly careful monitoring, and the required dose is, on mean, 10-20% lower than in ASA classes I and II.
丙泊酚是一种起效迅速的催眠药物，越来越多地用于内镜检查镇静。包括呼吸和心血管抑制在内的严重不良反应，使得许多内镜医师不愿在重症患者中使用丙泊酚。本研究描述了丙泊酚在连续的高危患者（美国麻醉医师协会[ASA]Ⅲ级和Ⅳ级）中的安全性概况，并与匹配的受试者（ASAⅠ级和Ⅱ级）进行比较。
在19个月的时间里，1370例高危患者接受了丙泊酚镇静，其中47%（614例ASAⅢ级，28例ASAⅣ级）与642例连续的、年龄和性别匹配的、接受相同内镜检查（395例胃镜检查，201例结肠镜检查，14例联合检查）的ASAⅠ级和Ⅱ级患者年龄匹配。注册护士通过丙泊酚剂量滴定进行所有镇静操作，同时仔细监测动脉血氧饱和度、心率和血压。
重症患者中未发生重大并发症。然而，ASAⅢ级和Ⅳ级患者出现短暂相关氧饱和度降低（<90%）的风险增加，为3.6%，而ASAⅠ级和Ⅱ级患者为1.7%（p = 0.036）。4例患者与1例患者相比，需要进行短暂面罩通气。此外，更大比例的患者氧饱和度下降≥5%。对动脉压或心率没有明显影响，336例结肠镜检查中未发生穿孔。
通过仔细监测，胃肠道内镜检查期间丙泊酚镇静是安全的，即使对于高危患者也是如此。考虑到他们较高的合并症发生率和氧饱和度降低的倾向，他们需要特别仔细的监测，并且平均所需剂量比ASAⅠ级和Ⅱ级患者低10%-20%。
