Tiankanon Kasenee, Mekaroonkamol Parit, Pittayanon Rapat, Kongkam Pradermchai, Gonlachanvit Sutep, Rerknimitr Rungsun
Center of Excellence for Innovation and Endoscopy in Gastrointestinal Oncology, Chulalongkorn University, Bangkok; Division of Gastroenterology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross, Bangkok, Thailand. .
Center of Excellence for Innovation and Endoscopy in Gastrointestinal Oncology, Chulalongkorn University, Bangkok; Division of Gastroenterology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross, Bangkok, Thailand.
J Gastrointestin Liver Dis. 2020 Dec 12;29(4):579-585. doi: 10.15403/jgld-2943.
As on-call anesthesiologist administered propofol sedation (OAPS) is costly and not readily available in all endoscopy units, endoscopy nurse administered propofol sedation (NAPS) can be an effective alternative. This study aimed to compare the dosage of propofol used by NAPS versus OAPS, cardiopulmonary adverse events and recovery time in low risk patients undergoing outpatient elective colonoscopy.
A retrospective propensity score-matched cohort study was conducted. Electronic medical records of elective colonoscopies performed by 3 experienced endoscopists from January 2016 to December 2019 were retrieved. OAPSs were performed by 10 certified anesthesiologists while NAPSs were performed by 8 experienced registered endoscopy nurses. Baseline characteristics, performing endoscopist, cecal intubation time, withdrawal time, propofol dosage per procedure, and adverse events were collected and analyzed using 3:1 (NAPS:OAPS) propensity score matching by age, performing endoscopist and difficulty of colonoscopy as co-variates with standardized mean deviation of <0.1.
278 eligible patients were included. After propensity score matching, there were 189 patients in NAPS and 63 in OAPS group for analysis. Demographic data were not different between the two groups. All procedures were technically successful with no difference in cecal intubation time (6.0±4 min vs 6.8±4 min; p=0.13) or total procedural time (17.2±16 min vs 16.3±6 min; p=0.66). Propofol dosage/kg/hour were significantly lower in the NAPS group, (11.4±4 mg/kg/hour vs. 16.6±8 mg/kg/hour; p<0.001). There were less minor cardiopulmonary adverse events in NAPS when compared to the OAPS group (2.2% vs 4.7%; p=0.014).
NAPS in elective colonoscopy in low-risk patients is as effective as OAPS but requires a significant lower dosage of propofol. Minor cardiopulmonary adverse events were recorded in the NAPS group compared to OAPS.
由于随叫随到的麻醉医生实施丙泊酚镇静（OAPS）成本高昂，且并非所有内镜检查科室都能随时提供，内镜护士实施丙泊酚镇静（NAPS）可能是一种有效的替代方案。本研究旨在比较NAPS与OAPS在接受门诊择期结肠镜检查的低风险患者中丙泊酚的使用剂量、心肺不良事件及恢复时间。
进行了一项回顾性倾向评分匹配队列研究。检索了2016年1月至2019年12月由3名经验丰富的内镜医生进行的择期结肠镜检查的电子病历。10名认证麻醉医生实施OAPS，8名经验丰富的注册内镜护士实施NAPS。收集并分析基线特征、实施内镜医生、盲肠插管时间、退镜时间、每次操作的丙泊酚剂量及不良事件，以年龄、实施内镜医生和结肠镜检查难度作为协变量，采用3:1（NAPS:OAPS）倾向评分匹配，标准化均数差值<0.1。
纳入278例符合条件的患者。倾向评分匹配后，NAPS组有189例患者，OAPS组有63例患者进行分析。两组的人口统计学数据无差异。所有操作在技术上均成功，盲肠插管时间（6.0±4分钟对6.8±4分钟；p=0.13）或总操作时间（17.2±16分钟对16.3±6分钟；p=0.66）无差异。NAPS组丙泊酚剂量/千克/小时显著更低（11.4±4毫克/千克/小时对16.6±8毫克/千克/小时；p<0.001）。与OAPS组相比，NAPS组轻微心肺不良事件更少（2.2%对4.7%；p=0.014）。
低风险患者择期结肠镜检查中NAPS与OAPS效果相当，但丙泊酚剂量显著更低。与OAPS组相比，NAPS组记录到轻微心肺不良事件。
