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Computer-Assisted Propofol Sedation for Esophagogastroduodenoscopy Is Effective, Efficient, and Safe

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Abstract

Background and Aims

Computer-assisted propofol sedation (CAPS) allows non-anesthesiologists to administer propofol for gastrointestinal procedures in relatively healthy patients. As the first US medical center to adopt CAPS technology for routine clinical use, we report our 1-year experience with CAPS for esophagogastroduodenoscopy (EGD).

Methods

Between September 2014 and August 2015, 926 outpatients underwent elective EGDs with CAPS at our center. All EGDs were performed by 1 of 17 gastroenterologists certified in the use of CAPS. Procedural success rates, procedure times, and recovery times were compared against corresponding historical controls done with midazolam and fentanyl sedation from September 2013 to August 2014. Adverse events in CAPS patients were recorded.

Results

The mean age of the CAPS cohort was 56.7 years (45% male); 16.2% of the EGDs were for variceal screening or Barrett’s surveillance and 83.8% for symptoms. The procedural success rates were similar to that of historical controls (99.0% vs. 99.3%; p = 0.532); procedure times were also similar (6.6 vs. 7.4 min; p = 0.280), but recovery time was markedly shorter (31.7 vs. 52.4 min; p < 0.001). There were 11 (1.2%) cases of mild transient oxygen desaturation (< 90%), 15 (1.6%) cases of marked agitation due to undersedation, and 1 case of asymptomatic hypotension. In addition, there were six (0.6%) patients with more pronounced desaturation episodes that required brief (< 1 min) mask ventilation. There were no other serious adverse events.

Conclusions

CAPS appears to be a safe, effective, and efficient means of providing sedation for EGD in healthy patients. Recovery times were much shorter than historical controls.

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Abbreviations

CAPS:

Computer-assisted propofol sedation

MF:

Midazolam fentanyl

NAPCIS:

Nurse-administered propofol continuous infusion sedation

NAPS:

Nurse-administered propofol sedation

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Acknowledgments

The authors would like to thank Drs. Elisa Boden, Blaire Burman, Shayan Irani, Geoffrey Jiranek, James Lord, Julia Pollock and Qing Zhang for their assistance and input.

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Authors and Affiliations

  1. Digestive Disease Institute, Virginia Mason Medical Center, 1100 Ninth Avenue, Seattle, WA, 98101, USA

    Otto S. Lin, Danielle La Selva, Richard A. Kozarek, Deborah Tombs, Johannes Koch, Susan McCormick, Michael Chiorean, Fred Drennan, Michael Gluck, Nanda Venu, Michael Larsen & Andrew Ross

  2. Department of Anesthesia, Virginia Mason Medical Center, Seattle, USA

    Wade Weigel & Ryan Beecher

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  1. Otto S. Lin
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  2. Danielle La Selva
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  4. Deborah Tombs
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  7. Johannes Koch
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  14. Andrew Ross
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Contributions

OL contributed to study conception and design; acquisition of data; analysis and interpretation of data; drafting of the manuscript; statistical analysis; final approval of the article. DLS contributed to study conception and design; execution of the study protocol; acquisition of data; analysis and interpretation of data; critical revision of the manuscript for important intellectual content; statistical analysis; final approval of the article. RK contributed to study conception and design; critical revision of the manuscript for important intellectual content; study supervision; final approval of the article. DT contributed to study conception and design; acquisition of data; revision of the manuscript for important intellectual content; final approval of the article. WW contributed to study conception and design; revision of the manuscript for important intellectual content; final approval of the article. RB contributed to study conception and design; revision of the manuscript for important intellectual content; final approval of the article. JK contributed to study conception and design; revision of the manuscript for important intellectual content; final approval of the article. SM contributed to study conception and design; revision of the manuscript for important intellectual content; final approval of the article. MC contributed to study conception and design; revision of the manuscript for important intellectual content; final approval of the article. FD contributed to study conception and design; revision of the manuscript for important intellectual content; final approval of the article. MG contributed to study conception and design; revision of the manuscript for important intellectual content; final approval of the article. NV contributed to study conception and design; revision of the manuscript for important intellectual content; final approval of the article. ML contributed to study conception and design; revision of the manuscript for important intellectual content; final approval of the article. AR contributed to study conception and design; critical revision of the manuscript for important intellectual content; study supervision; final approval of the article.

Corresponding author

Correspondence to Otto S. Lin.

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Conflict of interest

Dr. Lin served as a consultant for SEDASYS Inc up to 2016. Danielle La Selva declares no relevant disclosures. Richard A. Kozarek declares no relevant disclosures. Ms. Tombs served as a consultant for SEDASYS Inc up to 2016. Wade Weigel declares no relevant disclosures. Mr. Beecher served as a consultant for SEDASYS Inc up to 2016. Dr. Koch served as a consultant for SEDASYS Inc up to 2016. Susan McCormick declares no relevant disclosures. Michael Chiorean declares no relevant disclosures. Fred Drennan declares no relevant disclosures. Michael Gluck declares no relevant disclosures. Nanda Venu declares no relevant disclosures. Michael Larsen declares no relevant disclosures. Dr. Ross served as a consultant for SEDASYS Inc up to 2016.

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Lin, O.S., La Selva, D., Kozarek, R.A. et al. Computer-Assisted Propofol Sedation for Esophagogastroduodenoscopy Is Effective, Efficient, and Safe. Dig Dis Sci 64, 3549–3556 (2019). https://doi.org/10.1007/s10620-019-05685-5

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  • DOI: https://doi.org/10.1007/s10620-019-05685-5

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