Riphaus A, Geist F, Wehrmann T
Department of Medicine, Knappschaftskrankenhaus, Ruhr University Bochum.
Z Gastroenterol. 2013 Sep;51(9):1082-8. doi: 10.1055/s-0033-1335104. Epub 2013 Sep 10.
The use of sedation (e. g., of short-acting propofol) for gastrointestinal endoscopy has shown an upward trend in the USA and Europe over the last decade. To improve patient's safety different nationwide guidelines have been developed. This survey aimed at providing nationwide re-evaluated data 3 years after the implementation of consent- and evidence-based national guideline on sedation for gastrointestinal endoscopy.
A 24-item survey regarding current practices of endoscopy, sedation and monitoring in gastrointestinal endoscopy was sent to 4 405 members of the German Society of Digestive and Metabolic Diseases (DGVS).
A total of 741/4405 (17 %) questionnaires were returned. Compared to 2007 we documented a further increase of the use of sedation during the performance of esophagogastro-duodenoscopies (EGDs) (82 vs. 74 % in 2007) and colonoscopies (91 vs. 87 % in 2007), accompanied with an increased rate of using propofol as a sedative agent in 97 vs. 74 % of the cases in 2007. In contrast the use of midazolam substantially decreased to 69 % versus 82 % in 2007. Most commonly used sedation regimens are still propofol ± benzodiazepines (43 vs. 38 % in 2007), while a combination of midazolam ± opioid decreased to 15 % versus 35 % in 2007. Unchanged to data from 2007, patients were routinely monitored by pulse oximetry (99 %). Routine use of an automated blood pressure monitoring increased to 40 % (versus 29 % in 2007) and the use of electrocardiography monitoring nearly doubled to 24 vs. 13 % in 2007. Supplemental oxygen is nowadays routinely administered in 64 % compared to 34 % of the cases in 2007. Regarding the administration of sedation we observed a profound increase of nurse-administered propofol sedation (NAPS; 73 % in 2011, 39 % in 2007) with a decrease of endoscopist-directed propofol sedation (29 % in 2011 vs. 59 % in 2007). However, monitored anaesthesia care was still only rarely used in Germany (2 %).
After the implementation of the first national sedation guideline the use of propofol has become the most popular sedation regime in Germany, mainly administered as NAPS by trained nurses as a standard procedure. Automated blood pressure measurements and ECG recording were more often implemented in the monitoring practice and also the routine use of supplemental oxygen has been clearly improved.
在过去十年中，美国和欧洲使用镇静剂（如短效丙泊酚）进行胃肠内镜检查呈上升趋势。为提高患者安全性，已制定了不同的全国性指南。本调查旨在提供关于胃肠内镜检查镇静的基于同意书和证据的全国性指南实施三年后的全国重新评估数据。
向德国消化和代谢疾病学会（DGVS）的4405名成员发送了一份关于胃肠内镜检查中当前内镜检查、镇静和监测实践的24项调查问卷。
共返回741/4405份（17%）问卷。与2007年相比，我们记录到在食管胃十二指肠镜检查（EGD）期间镇静剂使用进一步增加（2007年为74%，现为82%），结肠镜检查中也是如此（2007年为87%，现为91%），同时使用丙泊酚作为镇静剂的比例从2007年的74%增加到97%。相比之下，咪达唑仑的使用大幅下降，从2007年的82%降至69%。最常用的镇静方案仍然是丙泊酚±苯二氮䓬类药物（2007年为38%，现为43%），而咪达唑仑±阿片类药物的联合使用从2007年的35%降至15%。与2007年的数据相比，患者仍常规通过脉搏血氧饱和度监测（99%）。自动血压监测的常规使用增加到了40%（2007年为29%），心电图监测的使用几乎翻了一番，从2007年的13%增至24%。如今，64%的病例常规给予补充氧气，而2007年这一比例为34%。关于镇静剂的给药，我们观察到护士给药的丙泊酚镇静（NAPS）显著增加（2011年为73%，2007年为39%），而内镜医师指导的丙泊酚镇静减少（2011年为29%，2007年为59%）。然而，德国监测麻醉护理的使用仍然很少（2%）。
在首个全国性镇静指南实施后，丙泊酚的使用已成为德国最流行的镇静方案，主要由经过培训的护士作为标准程序以NAPS方式给药。自动血压测量和心电图记录在监测实践中更常实施，补充氧气的常规使用也有明显改善。
