University of Utah, Salt Lake City, Utah, USA.
Gastrointest Endosc. 2021 Jul;94(1):124-130. doi: 10.1016/j.gie.2020.11.027. Epub 2020 Dec 10.
The safety of endoscopist-directed nurse-administered propofol sedation (EDNAPS) has been demonstrated in low-risk patients (American Society of Anesthesiologists [ASA] class I and II). There are limited data regarding the safety of EDNAPS for endoscopic procedures in ASA class III patients. The purpose of this study was to determine the safety of EDNAPS for routine outpatient endoscopy in this population.
We retrospectively reviewed all outpatient EGDs and colonoscopies performed with EDNAPS at the University of Utah from January 2015 to November 2018. Exclusion criteria were inpatient procedures, combined procedures, ASA IV or higher, use of continuous or bilevel positive airway pressure at the start of the procedure, or procedures performed by a nongastroenterologist. Major adverse events were defined as intubation or death. Minor adverse events were defined as hypoxia, hypotension, bradycardia, or need for airway interventions. Patients were stratified by procedure type and ASA I/II status and were compared with patients with ASA III status and matched according to age, gender, and the involvement of a fellow in a 3 to 1 fashion.
The final sample size was 18,910 colonoscopy procedures (17,205 patients) and 9178 EGD procedures (6827 patients). In both colonoscopy and EGD procedures, there were no major adverse events such as intubation, need for resuscitation, or death. The rates of any airway intervention, jaw thrust, oral nasal airway, or use of positive pressure ventilation were low in both procedure types and not different between ASA I/II and ASA III patients.
EDNAPS is safe in both ASA I/II and ASA class III patients undergoing routine outpatient endoscopy.
在低风险患者（美国麻醉医师协会 [ASA] 分级 I 和 II）中，已证明内镜医师指导下护士管理的异丙酚镇静（EDNAPS）的安全性。关于 ASA 分级 III 患者行内镜检查时 EDNAPS 的安全性数据有限。本研究的目的是确定该人群行常规门诊内镜检查时 EDNAPS 的安全性。
我们回顾性分析了 2015 年 1 月至 2018 年 11 月在犹他大学行 EDNAPS 的所有门诊上消化道内镜检查（EGD）和结肠镜检查。排除标准为住院患者、联合手术、ASA 分级 IV 或更高、手术开始时使用持续或双水平正压通气、或由非胃肠病学家进行的手术。主要不良事件定义为插管或死亡。次要不良事件定义为缺氧、低血压、心动过缓或需要气道干预。根据手术类型和 ASA I/II 状态对患者进行分层，并与 ASA III 状态的患者进行比较，并按照年龄、性别和以 3:1 的比例涉及同伴进行匹配。
最终样本量为 18910 例结肠镜检查（17205 例患者）和 9178 例 EGD（6827 例患者）。在结肠镜检查和 EGD 手术中，均未发生插管、需要复苏或死亡等主要不良事件。两种手术类型的气道干预、下颌推压、口鼻气道或使用正压通气的发生率均较低，且在 ASA I/II 和 ASA III 患者之间无差异。
ASA I/II 和 ASA 分级 III 患者行常规门诊内镜检查时，EDNAPS 是安全的。
