Digestive Disease Center, Showa Inan General Hospital, Komagane, Japan; Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan.
Digestive Disease Center, Showa Inan General Hospital, Komagane, Japan.
Clin Gastroenterol Hepatol. 2019 May;17(6):1098-1104.e1. doi: 10.1016/j.cgh.2018.06.025. Epub 2018 Jun 20.
BACKGROUND & AIMS: Esophagogastroduodenoscopy (EGD) and colonoscopy are common outpatient gastrointestinal endoscopic procedures that frequently use sedation. We aimed to identify a protocol that combines safety with cost effectiveness.
We collected data from consecutive outpatients (age, 20-98 y) who underwent diagnostic EGD (n = 117,661) or colonoscopy (n = 32,550) with propofol sedation from January 2006 through December 2016. Propofol was administered by a nurse via bolus injection using an age-adjusted standard protocol, up to a total of 200 mg. The primary outcome measure was occurrence of adverse events within 24 hours. Secondary outcome measures included rates of procedure success, respiratory depression, and other procedure-related adverse events.
The median dose of propofol administered for EGD was 77 mg (range, 20-160 mg) and for colonoscopy was 99 mg (range, 40-200 mg). Among patients undergoing EGD, those younger than 41 years required 1.5-fold more propofol than patients 61-80 years old. The only adverse event was the transient need for supplemental oxygen supply, required by 1950 patients (1.3%): 1689 undergoing EGD (1.4%) and 261 undergoing colonoscopy (0.8%). Patients were discharged after 60 minutes and at least 66,250 patients (44%) drove themselves from the hospital. None experienced a traffic accident within 24 hours after receiving propofol sedation.
Nurse-administered propofol monosedation using an age-adjusted standard protocol up to a maximal of 200 mg is safe and practical for outpatient gastrointestinal endoscopy.
食管胃十二指肠镜（EGD）和结肠镜检查是常见的门诊胃肠道内镜检查程序，经常使用镇静剂。我们旨在确定一种将安全性与成本效益结合起来的方案。
我们收集了 2006 年 1 月至 2016 年 12 月期间接受丙泊酚镇静下诊断性 EGD（n=117661）或结肠镜检查（n=32550）的连续门诊患者（年龄 20-98 岁）的数据。护士通过使用年龄调整的标准方案给予丙泊酚推注，最高剂量为 200mg。主要观察指标为 24 小时内不良事件的发生情况。次要观察指标包括程序成功率、呼吸抑制和其他与程序相关的不良事件。
EGD 中丙泊酚的中位剂量为 77mg（范围，20-160mg），结肠镜检查为 99mg（范围，40-200mg）。在接受 EGD 的患者中，年龄小于 41 岁的患者比 61-80 岁的患者需要多 1.5 倍的丙泊酚。唯一的不良事件是短暂需要补充氧气供应，有 1950 名患者（1.3%）需要：1689 名接受 EGD（1.4%）和 261 名接受结肠镜检查（0.8%）。患者在 60 分钟后出院，至少有 66250 名患者（44%）自行驾车离开医院。在接受丙泊酚镇静后 24 小时内，无人发生交通事故。
使用年龄调整的标准方案给予最高 200mg 的丙泊酚单药镇静，由护士管理，用于门诊胃肠道内镜检查是安全且实用的。
