Külling D, Rothenbühler R, Inauen W
Gastroenterology Center, Bürgerspital, Solothurn, Switzerland.
Endoscopy. 2003 Aug;35(8):679-82. doi: 10.1055/s-2003-41518.
In our endoscopy service, nonanesthetists administered propofol sedation has been used in more than 8000 procedures during the past 3 years. This study prospectively assessed the safety of propofol sedation in outpatient colonoscopy and esophagogastroduodenoscopy (EGD).
A total of 300 consecutive outpatients (mean age 53, range 14-94) were enrolled in the study (139 colonoscopies, 161 EGDs). After an initial dose of 0.5 mg/kg (ASA I-II and age </=70) or 0.25 mg/kg (ASA >III or age >70 years), propofol was titrated in 10 mg boluses to a steady state of sedation by the endoscopy nurse under the endoscopist's supervision. Colonoscopy patients also received 25 mg pethidine (meperidine) and 20 mg butylscopolamine, whereas EGDs were performed with propofol sedation alone, without topical pharyngeal anesthesia. In addition to standard monitoring with pulse oximetry and automated sphygmomanometry, patients were also observed with sidestream capnography or measurement of electrocardiographic impedance changes, providing real-time graphic assessment of respiratory activity. All patients were given oxygen 2 L/min by nasal cannula during the entire procedure.
Mean dosages of 157 mg (range 70-340) and 180 mg (60-400) propofol were administered for colonoscopy and EGD procedures, respectively. No episodes of apnea occurred. The oxygen saturation fell below 90 % for short periods of time in 11 patients (3.7 %). Three patients required a temporary increase in oxygen delivery. No assisted ventilation was necessary. In 22 patients (7.3 %), the mean blood pressure temporarily decreased below 50 mmHg. Two patients received a 500-ml infusion of normal saline.
Propofol can be safely administered for sedation during colonoscopy and esophagogastroduodenoscopy by nonanesthetists who are familiar with the pharmacological properties and use of this drug.
在我们的内镜诊疗服务中，过去3年里非麻醉师实施丙泊酚镇静已应用于8000余例手术。本研究前瞻性评估了丙泊酚镇静在门诊结肠镜检查和食管胃十二指肠镜检查（EGD）中的安全性。
共纳入300例连续门诊患者（平均年龄53岁，范围14 - 94岁）进行研究（139例结肠镜检查，161例EGD）。初始剂量为0.5 mg/kg（ASA I-II且年龄≤70岁）或0.25 mg/kg（ASA>III或年龄>70岁）后，在内镜医师监督下，由内镜护士以10 mg推注的方式滴定丙泊酚至稳定的镇静状态。结肠镜检查患者还接受25 mg哌替啶（度冷丁）和20 mg丁溴东莨菪碱，而EGD仅采用丙泊酚镇静，不进行咽部表面麻醉。除了采用脉搏血氧饱和度仪和自动血压计进行标准监测外，还通过旁流二氧化碳监测或测量心电图阻抗变化对患者进行观察，以实时图形方式评估呼吸活动。整个手术过程中所有患者均通过鼻导管给予2 L/min的氧气。
结肠镜检查和EGD手术中丙泊酚的平均剂量分别为157 mg（范围70 - 340）和180 mg（60 - 400）。未发生呼吸暂停事件。11例患者（3.7%）的血氧饱和度短时间降至90%以下。3例患者需要临时增加氧气供应量。无需辅助通气。22例患者（7.3%）的平均血压暂时降至50 mmHg以下。2例患者接受了500 ml生理盐水输注。
熟悉该药药理特性和用法的非麻醉师可安全地在结肠镜检查和食管胃十二指肠镜检查期间给予丙泊酚进行镇静。
