Ooi Marie, Thomson Andrew
The Canberra Hospital, Gastroenterology Unit, Canberra, Australian Capital Territory 2600, Australia.
Endosc Int Open. 2015 Oct;3(5):E393-7. doi: 10.1055/s-0034-1392511. Epub 2015 Aug 11.
Endoscopist-Directed Nurse-Administered Propofol Sedation (EDNAPS) has been evaluated in community settings rather than tertiary referral centers.
A hospital-wide prospectively collected database of Medical Emergency Team Calls (METCALL), emergency responses triggered by medically unstable patients, was reviewed. Responses that followed EDNAPS were extracted and compared with a prospectively entered database of all endoscopies performed using EDNAPS over the same period.
A total of 33,539 endoscopic procedures (16,393 gastroscopies, 17,146 colonoscopies) were performed on 27,989 patients using EDNAPS. Intravenous drugs included midazolam (0 - 5 mg), fentanyl (0 - 100 mcg), and propofol (10 - 420 mg). Of 23 METCALLs (18 gastroscopies and 5 colonoscopies), there were 16 with ASA scores of III or higher. Indications for gastroscopy were gastrointestinal (GI) hemorrhage (n = 11; 8 variceal, 3 nonvariceal), dysphagia (n = 5), PEG removal (n = 1), and dyspepsia (n = 1). Fifteen of 22 patients, including all of those who had a colonoscopy, made a full recovery and returned to the ward or were discharged home. In the gastroscopy group, seven were intubated and admitted to Intensive Care, of whom six were emergency cases for gastrointestinal bleeding (n = 4 variceal, n = 2 non variceal) and one in which the indication was PEG removal. Two deaths occurred in the intubated group.
In a tertiary referral center, EDNAPS for low-to-moderate risk (ASA ≤ 2) patients undergoing gastroscopy and colonoscopy is very safe. Gastroscopy is associated with greater anesthetic risk than colonoscopy and those with high ASA scores needing urgent endoscopy for upper gastrointestinal hemorrhage are at particular risk of cardiorespiratory decompensation.
内镜医师指导下护士给予丙泊酚镇静（EDNAPS）已在社区环境而非三级转诊中心进行了评估。
回顾了一个全院范围内前瞻性收集的医疗急救团队呼叫（METCALL）数据库，该数据库记录了由病情不稳定患者触发的紧急响应情况。提取了遵循EDNAPS的响应情况，并与同期使用EDNAPS进行的所有内镜检查的前瞻性录入数据库进行比较。
共对27,989例患者进行了33,539例内镜检查（16,393例胃镜检查，17,146例结肠镜检查），使用了EDNAPS。静脉用药包括咪达唑仑（0 - 5毫克）、芬太尼（0 - 100微克）和丙泊酚（10 - 420毫克）。在23次METCALL中（18例胃镜检查和5例结肠镜检查），有16例美国麻醉医师协会（ASA）评分在III级或更高。胃镜检查的适应证包括胃肠道（GI）出血（n = 11；8例静脉曲张出血，3例非静脉曲张出血）、吞咽困难（n = 5）、经皮内镜下胃造口术（PEG）移除（n = 1）和消化不良（n = 1）。22例患者中有15例完全康复，返回病房或出院回家，包括所有接受结肠镜检查的患者。在胃镜检查组中，7例患者插管并入住重症监护病房，其中6例是胃肠道出血的急诊病例（n = 4例静脉曲张出血，n = 2例非静脉曲张出血），1例适应证为PEG移除。插管组中有2例死亡。
在三级转诊中心，对于低至中度风险（ASA≤2）的接受胃镜检查和结肠镜检查的患者，EDNAPS非常安全。胃镜检查比结肠镜检查的麻醉风险更高，而ASA评分高且因上消化道出血需要紧急内镜检查的患者尤其有发生心肺功能失代偿的风险。
