Tohda G, Higashi S, Wakahara S, Morikawa M, Sakumoto H, Kane T
Dept. of Gastroenterology, Yujin Yamazaki Hospital, Hikone, Japan.
Endoscopy. 2006 Apr;38(4):360-7. doi: 10.1055/s-2005-921192.
Propofol has several attractive properties, including a rapid onset of action and rapid recovery. However, the administration of propofol sedation in the absence of anesthesiologists remains controversial. This report describes the safety profile of propofol sedation for endoscopy when administered by registered nurses under the supervision of endoscopists.
The study was conducted in the endoscopic center of a Japanese private hospital. With assistance from an anesthesiologist, a protocol for administration of propofol by registered nurses was developed. Over the past 6 years, 27,500 patients received nurse-administered propofol sedation. The safety and patient satisfaction with this sedation procedure were evaluated.
Among the participating patients, 6.7% developed hypoxemia (Sp(O2) < 90%); 6.2% required oxygen administration via a nasal cannula. Severe hypoxemia (Sp(O2) < 85%) occurred in 121 patients (0.62%) during upper gastrointestinal endoscopy and 20 patients (0.25%) during colonoscopy, but neither mask ventilation nor endotracheal intubation was necessary. A decline in blood pressure (systolic blood pressure < 90 mm Hg) was seen in 3.5% of the colonoscopy patients and 1.2% of the upper endoscopy patients. However, hypotension was corrected immediately using an intravenous saline solution. Patients who received propofol sedation expressed overall satisfaction on a 10-point visual analogue scale (with an average of 9.4 points). Among patients who had previously received a combination of midazolam and pethidine for colonoscopy, 85% preferred propofol sedation. The mean time from the end of the procedure to full recovery was 14.6 min.
Administration of propofol by registered nurses under the supervision of endoscopists was safe, and resulted in high rates of patient satisfaction.
丙泊酚具有多种吸引人的特性，包括起效迅速和恢复快。然而，在没有麻醉医生在场的情况下给予丙泊酚镇静仍存在争议。本报告描述了在内镜医师监督下由注册护士给予丙泊酚进行内镜检查镇静的安全性。
该研究在一家日本私立医院的内镜中心进行。在一名麻醉医生的协助下，制定了由注册护士给予丙泊酚的方案。在过去6年中，27500例患者接受了护士给予的丙泊酚镇静。对这种镇静程序的安全性和患者满意度进行了评估。
在参与研究的患者中，6.7%出现低氧血症（脉搏血氧饱和度<90%）；6.2%需要通过鼻导管吸氧。严重低氧血症（脉搏血氧饱和度<85%）在上消化道内镜检查期间发生在121例患者（0.62%）中，在结肠镜检查期间发生在20例患者（0.25%）中，但均无需面罩通气或气管插管。3.5%的结肠镜检查患者和1.2%的上消化道内镜检查患者出现血压下降（收缩压<90mmHg）。然而，通过静脉输注生理盐水立即纠正了低血压。接受丙泊酚镇静的患者在10分视觉模拟量表上总体满意度较高（平均9.4分）。在之前接受过咪达唑仑和哌替啶联合用于结肠镜检查的患者中，85%更喜欢丙泊酚镇静。从检查结束到完全恢复的平均时间为14.6分钟。
在内镜医师监督下由注册护士给予丙泊酚是安全的，并导致了较高的患者满意度。
