Patel Janaki, Fang John, Taylor Linda J, Adler Douglas G, Gawron Andrew J
Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, United States.
Endosc Int Open. 2019 Apr;7(4):E625-E629. doi: 10.1055/a-0829-6284. Epub 2019 Apr 12.
Propofol sedation is an increasingly popular method of sedation for gastrointestinal endoscopic procedures. The safety and efficacy of the non-anesthesiologist administration of propofol (NAAP) sedation has been demonstrated in the ambulatory setting. However, NAAP sedation in intensive care unit (ICU) patients has not been reported. The purpose of this study is to determine safety and efficacy of NAAP sedation in an ICU population. We retrospectively reviewed esophagogastroduodenoscopies (EGD) performed with NAAP sedation in our intensive care units from June 2014 to September 2016. All EGDs were performed for evaluation of gastrointestinal bleeding. The primary end point of this study was to analyze the incidence of sedation-related adverse events (AEs). The secondary end points included successful completion of procedure and any endoscopic interventions performed. Two of 161 procedures (1.2 %) had sedation-related AEs requiring procedure termination. One hundred forty-six of 161 procedures (90.7 %) were successfully completed. Incomplete procedures were due to excess heme, retained food or obstructive lesions (13/161, 8.1 %). Endoscopic intervention was performed successfully in 17/24 cases (70.8 %) that had endoscopically treated lesions identified. One hundred six of 161 patients (66 %) were American Society of Anesthesiologists (ASA) classification III or IV. Our retrospective analysis demonstrated that EGDs can be successfully completed in ICU patients using NAAP sedation. When procedures cannot be completed, it is rarely due to sedation-related AEs. NAAP sedation further allows adequate examination and successful treatment of high-risk lesions. NAAP sedation appears safe and effective for endoscopic procedures in the ICU setting.
丙泊酚镇静是一种在胃肠内镜检查中越来越常用的镇静方法。非麻醉医生实施丙泊酚（NAAP）镇静的安全性和有效性已在门诊环境中得到证实。然而，重症监护病房（ICU）患者的NAAP镇静尚未见报道。本研究的目的是确定NAAP镇静在ICU患者中的安全性和有效性。
我们回顾性分析了2014年6月至2016年9月在我们重症监护病房接受NAAP镇静的食管胃十二指肠镜检查（EGD）。所有EGD均用于评估胃肠道出血。本研究的主要终点是分析镇静相关不良事件（AE）的发生率。次要终点包括手术成功完成情况和任何内镜干预措施。
161例手术中有2例（1.2%）出现与镇静相关的AE，需要终止手术。161例手术中有146例（90.7%）成功完成。手术未完成是由于血色素过多、食物残留或梗阻性病变（13/161，8.1%）。在24例经内镜发现有病变需要治疗的患者中，17例（70.8%）成功进行了内镜干预。161例患者中有106例（66%）为美国麻醉医师协会（ASA）III或IV级。
我们的回顾性分析表明，使用NAAP镇静可在ICU患者中成功完成EGD。当手术无法完成时，很少是由于镇静相关的AE。NAAP镇静还能对高危病变进行充分检查和成功治疗。NAAP镇静在ICU环境下的内镜检查中似乎是安全有效的。
