Digestive Diseases and Sciences

, Volume 55, Issue 9, pp 2537–2544 | Cite as

Comparison of Propofol Deep Sedation Versus Moderate Sedation During Endosonography

  • D. S. Nayar
  • W. G. Guthrie
  • A. Goodman
  • Y. Lee
  • M. Feuerman
  • L. Scheinberg
  • F. G. Gress
Original Article
First Online:
Received:
Accepted:

Abstract

Background

The purposes of this study are: (1) to prospectively evaluate clinically relevant outcomes including sedation-related complications for endoscopic ultrasound (EUS) procedures performed with the use of propofol deep sedation administered by monitored anesthesia care (MAC), and (2) to compare these results with a historical case–control cohort of EUS procedures performed using moderate sedation provided by the gastrointestinal (GI) endoscopist.

Materials And Methods

Patients referred for EUS between January 1, 2001 and December 31, 2002 were enrolled. Complication rates for EUS using MAC sedation were observed and also compared with a historical case–control cohort of EUS patients who received meperidine/midazolam for moderate sedation, administered by the GI endoscopist. Logistic regression analysis was used to isolate possible predictors of complications.

Results

A total of 1,000 patients underwent EUS with propofol sedation during the period from January 1, 2001 through December 31, 2002 (mean age 64 years, 53% female). The distribution of EUS indications based on the primary area of interest was: 170 gastroduodenal, 92 anorectal, 508 pancreaticohepatobiliary, 183 esophageal, and 47 mediastinal. The primary endpoint of the study was development of sedation-related complications occurring during a performed procedure. A total of six patients experienced complications: duodenal perforation (one), hypotension (one), aspiration pneumonia (one), and apnea requiring endotracheal intubation (three). The complication rate with propofol was 0.60%, compared with 1% for the historical case–control (meperidine/midazolam moderate sedation) group.

Conclusions

There does not appear to be a significant difference between complication rates for propofol deep sedation with MAC and meperidine/midazolam administered for moderate sedation.

Keywords

Endoscopic ultrasound EUS Propofol Deep sedation Complications 
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References

  1. 1.
    Astra Zeneca Diprivan prescriber information package, July 2004.Google Scholar
  2. 2.
    Rex D, Overley C, Kinser K, et al. Safety of propofol administered by registered nurses with gastroenterologist supervision in 2000 endoscopic cases. Am J Gastroenterol. 2002;97(5):1159–1163.CrossRefPubMedGoogle Scholar
  3. 3.
    Horiuchi A, Nakayama Y, Katsuyama Y, et al. Safety and driving ability following low dose propofol sedation. Digestion. 2008;78:190–194.CrossRefPubMedGoogle Scholar
  4. 4.
    Vargo J, Zuccaro G, Dumot J, et al. Gastroenterologist-administered propofol for therapeutic upper endoscopy with graphic assessment of respiratory activity: a case series. Gastrointest Endosc. 2000;52(2):250–255.CrossRefPubMedGoogle Scholar
  5. 5.
    Weston B, Chadalawada V, Chalasani N, et al. Nurse-administered propofol versus midazolam and meperidine for upper endoscopy in cirrhotic patients. Am J Gastroenterol. 2003;98(11):2440–2447.CrossRefPubMedGoogle Scholar
  6. 6.
    Cordruwisch W, Doroschko M, Wurbs D. Deep sedation in gastrointestinal endoscopic interventions: safety and reliability of a combination of midazolam and propofol. Dtsch Med Wochenschr. 2000;125(20):619–622.CrossRefPubMedGoogle Scholar
  7. 7.
    Vargo J, Zuccaro G, Dumot J, et al. Gastroenterologist-administered propofol versus meperidine and midazolam for advanced upper endoscopy: a prospective, randomized trial. Gastroenterology. 2002;123(1):8–16.CrossRefPubMedGoogle Scholar
  8. 8.
    Benjamin S. Complications of moderate sedation. Gastrointest Endosc Clin North Am. 1996;6(2):277–286.Google Scholar
  9. 9.
    Heuss L, Schnieper P, Drewe J, et al. Risk stratification and safe administration of propofol by registered nurses supervised by the gastroenterologist: a prospective observational study of more than 2000 cases. Gastrointest Endosc. 2003;57:664–671.CrossRefPubMedGoogle Scholar
  10. 10.
    Sipe B, Rex D, Latinovich D, et al. Propofol versus midazolam/meperidine for outpatient colonoscopy: administration by nurses supervised by endoscopists. Gastrointest Endosc. 2002;55(7):815–825.CrossRefPubMedGoogle Scholar
  11. 11.
    Kulling D, Fantin A, Biro P, et al. Safer colonoscopy with patient-controlled analgesia and sedation with propofol and alfentanil. Gastrointest Endosc. 2001;54(1):1–7.CrossRefPubMedGoogle Scholar
  12. 12.
    Nelson D, Barkun A, Block K, et al. Propofol use during gastrointestinal endoscopy. Gastrointest Endosc. 2001;53(7):876–879.PubMedGoogle Scholar
  13. 13.
    Wehrmann T, Kokabpick S, Lembcke B, et al. Efficacy and safety of intravenous propofol sedation during routine ERCP: a prospective, controlled study. Gastrointest Endosc. 1999;49:677–683.CrossRefPubMedGoogle Scholar
  14. 14.
    Cote GA, Hovis RM, Ansstas MA, Waldbaum L, Azar RR, Early DS, Edmundowicz SA, Mullady DK, Jonnalagadda SS. Incidence of sedation-related complications with propofol use during advanced endoscopic procedures. Clin Gastroenterol Hepatol. 2009; (Epub ahead of print).Google Scholar
  15. 15.
    Chak A, Cooper G. Procedure-specific outcomes assessment for endoscopic ultrasonography. Gastrointest Endosc. 1999;9(4):649–656.Google Scholar
  16. 16.
    Gress F, Schmitt C, Sherman S, et al. Endoscopic ultrasound-guided celiac plexus block for managing abdominal pain associated with chronic pancreatitis: a prospective single center experience. Am J Gastroenterol. 2001;96(2):409–416.CrossRefPubMedGoogle Scholar
  17. 17.
    Faigel DO, Eisen GM, Baron TH, et al. Standards of practice committee. American society for gastrointestinal endoscopy. Preparation of patients for GI endoscopy. Gastrointest Endosc. 2003;57(4):446–450.CrossRefPubMedGoogle Scholar
  18. 18.
    Faigel DO, Baron TH, Goldstein JL, et al. Standards practice committe, American society for gastrointestinal endoscopy. Guidelines for the use of deep sedation and anesthesia for GI endoscopy. Gastrointest Endosc. 2002;56(5):613–617.CrossRefPubMedGoogle Scholar
  19. 19.
    Koshy G, Nair S, Norkus E. Propofol versus midazolam and meperidine for moderate sedation in GI endoscopy. Am J Gastroenterol. 2001;95(6):1476–1479.CrossRefGoogle Scholar
  20. 20.
    Dewitt J, McGreevy K, Sherman S, Imperiale TF. Nurse-administered propofol sedation compared with midazolam and meperidine for EUS: a prospective, randomized trial. Gastrointest Endosc. 2008;68(3):499–509.CrossRefPubMedGoogle Scholar
  21. 21.
    Wehrmann T, Riphaus A. Sedation with propofol for interventional endoscopic procedures: a risk factor analysis. Scand J Gastroenterol. 2008;43(3):368–374.CrossRefPubMedGoogle Scholar
  22. 22.
    Walker J, Schleinitz P, Jacobson K, et al. Propofol: Multiple advantages for endoscopy and colonoscopy in 1424 consecutive patients. Gastrointest Endosc. 2000;51(4):AB59.Google Scholar
  23. 23.
    Khanna S, Tobin R, Khare S, et al. Propofol- a safe and effective sedative for endoscopy. Indian J Gastroenterol. 2003;22:56–58.PubMedGoogle Scholar
  24. 24.
    Graber R. Propofol in the endoscopy suite: an anesthesiologist’s perspective. Gastrointest Endosc. 1999;49:803–806.CrossRefPubMedGoogle Scholar
  25. 25.
    Dubois A, Balatoni E, Peeters J, et al. Use of propofol for sedation during gastrointestinal endoscopies. Anaesthesia. 1998;43(suppl):75–80.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • D. S. Nayar
    • 1
  • W. G. Guthrie
    • 4
  • A. Goodman
    • 4
  • Y. Lee
    • 4
  • M. Feuerman
    • 2
  • L. Scheinberg
    • 3
  • F. G. Gress
    • 4
  1. 1.Gastroenterology Associates of Central JerseyEdisonUSA
  2. 2.Department of BiostatisticsWinthrop University HospitalMineolaUSA
  3. 3.Department of AnesthesiologyWinthrop University HospitalMineolaUSA
  4. 4.Division of GastroenterologySUNY-Downstate Medical CenterBrooklynUSA

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