Introduction
Propofol administration managed directly by the gastroenterologist is a sedation regimen, which is broadly spreading, in clinical practice in Endoscopy Units (EU) all over the world [1]. This is primarily due to a very high patient and endoscopist satisfaction. Moreover, fears associated with propofol use by non-anesthesia providers are based on sound theoretical principles. Non-anesthesiologist-administered-propofol (NAAPS) managed by the gastroenterologist is an issue still controversial for many anesthesiologist societies.
Aims & Methods
This study aims to analyze safety outcomes between NAAPS sedation and anesthesiologist-assisted deep sedation during endoscopic procedures for low-risk patients. We retrospectively assessed data from low anesthesiologist risk-patients (American Society of Anesthesiologists I-II), undergone esophagogastroduodenoscopies (EGDs) and colonoscopies under NAAPS sedation, and assisted anesthesiologist-deep sedation, between May 2019 and October 2021, in a tertiary center. Primary outcome was to compare sedation related-adverse events rates between NAAPS and deep sedation. Propensity score matching analysis was performed using sex, age, Body Mass Index (BMI), smoking, comorbidities and time examination in order to standardize baseline variables.
Results
Overall, in colonoscopies subset, 2491 patients were managed under NAAPS and 257 patients under deep sedation, whereas in EGDs subset, 2439 patients were managed under NAAPS and 282 patients under deep sedation. In unmatched analysis, no difference was shown in terms of adverse events rates between NAAPS and deep sedation, both in EGDs and colonoscopies subsets (1.8% vs 3.5%; p=0.202 and 1 vs 0,4%, p=0.815, respectively). After matching, EGDs subset analysis comprised 282 procedures in NAAPS group versus 188 in deep sedation group, whereas colonoscopies subset included 256 patients in NAAPS group and 174 in deep sedation group. Matched analysis revealed non-different adverse events rate between moderate and deep sedation groups (colonoscopies 3.5% vs 0.6%, p=0.249 and EGD 0.4% vs 1%, p=0.452, respectively).
Conclusion
NAAPS during endoscopy represents a safe sedation modality, comparable with safety outcomes of anesthesiologist-assisted deep sedation. Cost-efficacy analyses are needed, in order to highlight economic advantages of non-anesthesiologist management of propofol during endoscopy.
References
[1] Gouda B, Gouda G, Borle A, Singh A, Sinha A, Singh PM. Safety of non-anesthesia provider administered propofol sedation in non-advanced gastrointestinal endoscopic procedures: A meta-analysis. Saudi J Gastroenterol. 2017;23(3):133-143. doi:10.4103/sjg.SJG_501_16
Disclosure
Prof.Silvio Danese has served as a speaker, consultant, and advisory board member for Schering-Plough, AbbVie, Actelion, Alphawasserman, AstraZeneca, Cellerix, Cosmo Pharmaceuticals, Ferring, Genentech, Grunenthal, Johnson and Johnson, Millenium Takeda, MSD, Nikkiso Europe GmbH, Novo Nordisk, Nycomed, Pfizer, Pharmacosmos, UCB Pharma and Vifor. The other authors declare no conflict of interests.