Endoscopy Unit, Department of Gastroenterology and Hepatology, Hospital Universitario Virgen de Nieves, Granada, Spain.
Eur J Gastroenterol Hepatol. 2012 May;24(5):506-12. doi: 10.1097/MEG.0b013e328350fcbd.
Only a few reports have addressed non-anesthesiologist-administered propofol for endoscopic ultrasonography (EUS), but none specifically in high-risk patients. Our aim was to study the application of a propofol sedation protocol for EUS in average-risk and high-risk patients.
This was a prospective observational study including 446 patients referred for EUS. We analyzed the induction time, procedure duration, recovery times, and patients' comfort and safety. Sedation was administered by a trained nurse, under the guidance of the endoscopist. We continuously monitored vital signs as well as patient cooperation and tolerance. Complications, patient, and endoscopist satisfaction were analyzed.
No major complications occurred. The rate of minor complications was 9%, the most frequent being hypoxemia (8%). One hundred and thirty-eight high-risk patients were included [American Society of Anesthesiologists (ASA) III-IV]. Average-risk patients received higher propofol doses (202.9 ± 84.8 vs. 164.8 ± 84.3; P=0.003). No differences were found in the rate of complications or procedure-related variables. Overall patient and endoscopist satisfaction was excellent. The logistic regression model identified propofol doses (P=0.02) as a risk factor and ASA-I classification (P=0.03) as a protective factor for the appearance of complications.
Non-anesthesiologist-administered propofol for upper EUS in high-risk and average-risk patients is safe and could be routinely offered to high-risk and elderly patients.
仅有少数几篇报告涉及非麻醉医师管理的丙泊酚用于内镜超声检查（EUS），但均未特别针对高危患者。我们的目的是研究在中危和高危患者中应用丙泊酚镇静方案进行 EUS 的情况。
这是一项前瞻性观察性研究，纳入了 446 例接受 EUS 检查的患者。我们分析了诱导时间、操作持续时间、恢复时间以及患者的舒适度和安全性。镇静由经过培训的护士在内镜医师的指导下进行。我们持续监测生命体征以及患者的配合和耐受性。分析了并发症、患者和内镜医师的满意度。
未发生重大并发症。轻微并发症的发生率为 9%，最常见的是低氧血症（8%）。纳入了 138 例高危患者[美国麻醉医师协会（ASA）III-IV 级]。中危患者接受的丙泊酚剂量更高（202.9±84.8 比 164.8±84.3；P=0.003）。并发症发生率或与操作相关的变量无差异。总体上患者和内镜医师的满意度均很高。Logistic 回归模型确定丙泊酚剂量（P=0.02）是并发症出现的危险因素，ASA-I 分级（P=0.03）是并发症出现的保护因素。
非麻醉医师管理的高危和中危患者的上消化道 EUS 中应用丙泊酚是安全的，可以常规提供给高危和老年患者。
