Gouda Basavana, Gouda Gowri, Borle Anuradha, Singh Akash, Sinha Ashish, Singh Preet M
Department of Anesthesia, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Department of Anesthesia, All Institute of Medical Sciences, New Delhi, India.
Saudi J Gastroenterol. 2017 May-Jun;23(3):133-143. doi: 10.4103/sjg.SJG_501_16.
BACKGROUND/AIMS: The aim of the study was to evaluate the safety of non-anesthesia provider (NAPP) administered propofol sedation in patients undergoing non-advanced gastrointestinal (GI) endoscopic procedures.
Pubmed, Embase, Cochrane central register of controlled trials, Scopus, and Web of Science databases were searched for prospective observational trials involving non-advanced endoscopic procedures. From a total of 608 publications, 25 [colonoscopy (9), upper GI endoscopy (5), and combined procedures (11)] were identified to meet inclusion criteria and were analyzed. Data was analyzed for hypoxia rates, airway intervention rates, and airway complication rates.
A total of 137,087 patients were involved. A total of 2931 hypoxia episodes (defined as an oxygen saturation below 90%) were reported with a pooled hypoxia rate of 0.014 (95% CI being 0.008-0.023). Similarly, pooled airway intervention rates and pooled airway complication rates were 0.002 (95% CI being 0.006-0.001) and 0.001 (95% CI being 0.000-0.001), respectively.
The rates of adverse events in patients undergoing non-advanced GI endoscopic procedures with NAPP sedation are extremely small. Similar data for anesthesia providers is not available. It is prudent for anesthesia providers to demonstrate their superiority in prospective randomized controlled trials, if they like to retain exclusive ownership over propofol sedation in patients undergoing GI endoscopy.
背景/目的：本研究旨在评估在非高级胃肠道（GI）内镜检查过程中，由非麻醉专业人员（NAPP）给予丙泊酚镇静的安全性。
检索了PubMed、Embase、Cochrane对照试验中央注册库、Scopus和Web of Science数据库，以查找涉及非高级内镜检查的前瞻性观察性试验。从总共608篇出版物中，确定了25篇[结肠镜检查（9篇）、上消化道内镜检查（5篇）和联合手术（11篇）]符合纳入标准并进行分析。分析了低氧血症发生率、气道干预率和气道并发症发生率的数据。
总共纳入了137,087例患者。共报告了2931次低氧血症发作（定义为氧饱和度低于90%），汇总低氧血症发生率为0.014（95%置信区间为0.008 - 0.023）。同样，汇总气道干预率和汇总气道并发症发生率分别为0.002（95%置信区间为0.006 - 0.001）和0.001（95%置信区间为0.000 - 0.001）。
在接受非高级GI内镜检查并采用NAPP镇静的患者中，不良事件发生率极低。目前尚无麻醉专业人员的类似数据。如果麻醉专业人员希望在接受GI内镜检查的患者中保留丙泊酚镇静的独占权，那么在进行前瞻性随机对照试验中证明其优越性是明智的。
