Safety of Non-anesthesiologist Administration of Propofol for Gastrointestinal Endoscopy

Jun Kyu Lee; Dong Kee Jang; Won Hee Kim; Jung-Wook Kim; Byung Ik Jang

doi:10.4166/kjg.2017.69.1.55

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Lee, Jang, Kim, Kim, and Jang: Safety of Non-anesthesiologist Administration of Propofol for Gastrointestinal Endoscopy

Review Article

Korean J Gastroenterol 2017;69(1):55-58.

Published online: 4 October 2017

DOI: https://doi.org/10.4166/kjg.2017.69.1.55

Safety of Non-anesthesiologist Administration of Propofol for Gastrointestinal Endoscopy

Jun Kyu Lee, Dong Kee Jang, Won Hee Kim¹, Jung-Wook Kim², Byung Ik Jang³

Department of Internal Medicine, Dongguk University College of Medicine, Goyang, Korea

¹Department of Internal Medicine, CHA University, Seongnam, Korea

²Department of Internal Medicine, College of Medicine, Kyung Hee University, Seoul, Korea

³Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea

Correspondence to: Byung Ik Jang, Department of Internal Medicine, Yeungnam University College of Medicine, 170 Hyeonchung-ro, Nam-gu, Daegu 42415, Korea. Tel: +82-53-620-3831, Fax: +82-53-654-8386, E-mail: jeromee1971@yahoo.co.kr

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Propofol (2,6-diisopropylphenol) is a hypnotic drug with a very rapid onset and offset of action. It has increasingly been used in gastrointestinal endoscopy. Administration of propofol by nurses or endoscopists is commonly referred to as non-anesthesiologist-ad-ministered propofol (NAAP). There have been a lot of studies on the safety of NAAP compared with those by anesthesiologists. Safety results of those studies are summarized in this review.

Keywords: Propofol, Safety, Sedation, Gastrointestinal Endoscopy

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Table 1.

The Summary of Studies Regarding Non-anesthesiologist Administration of Propofol

Reference	N	Endoscopy	Propofol administrator	Comparison	Safety
Vargo et al. (2002)⁴	75	ERCP, EUS	Endoscopist	Midazolam/meperidine	No difference in procedure-related cardiopulmonary data
Clarke et al. (2002)⁵	28,472	EGD, CFS	General physician	Anesthesiologist	No difference in respiratory events, but more intervention in the general physician group (p=0.03)
Weston et al. (2003)⁶	20	EGD	Nurse	Midazolam/meperidine	No difference in procedure-related vital sign changes
Kulling et al. (2003)⁷	300	EGD, CFS	Nurse	−	No significant adverse event
Dewitt et al. (2008)⁸	80	EUS	Nurse	Midazolam/meperidine	No difference in major adverse effects (p=0.83)
Horiuchi et al. (2009)⁹	10,662	EGD	Nurse	−	Temporary O₂ supply in 0.26%, no use of mask or mechanical ventilator
Schilling et al. (2009)¹⁰	150	ERCP, EUS, DBE	Nurse	Midazolam/meperidine	Overall cardiopulmonary complication 23.7 % vs. 16% (p>0.05)
Poincloux et al. (2011)¹¹	90	CFS	Endoscopist	Anesthesiologist	more hypoxia in the anesthesiologist group (3 vs. 16, p<0.008)
Lucendo et al. (2012)¹²	1,000	CFS	Nurse	−	Temporary hypoxia 2.4%
de Paulo et al. (2015)¹³	2,000	EGD, CFS	Endoscopist	Anesthesiologist	Temporary hypoxia 12.8% vs. 11.2% (p=0.3)
Goudra et al. (2015)¹⁴	5,392	All (meta-analysis)	Non-anesthesiologist	Anesthesiologist	Temporary hypoxia 0.133 vs. 0.143, respiratory intervention 0.035 vs. 0.133
Yamamoto et al. (2015)¹⁵	106⁵	EGD	Endoscopist	Midazolam	No difference in procedure-related vital sign changes
Park et al. (2001)¹⁶	153	EGD	Endoscopist	Midazolam	Low mean arterial oxygen saturation and systolic blood pressure in the propofol group, but no significant event
Oh et al. (2005)¹⁷	81	CFS	Nurse	Patient-controlled sedation	No difference in procedure-related vital sign changes (blood pressure, pulse rate, oxygen saturation)
Koo et al. (2007)¹⁸	56	CFS	Nurse	Midazolam	No difference in both complication and procedure-related vital sign changes (blood pressure, pulse rate, oxygen saturation)
Oh et al. (2013)³⁷	62 (children)	EGD	Nurse	Midazolam	No difference in major adverse effects

ERCP, endoscopic retrograde cholangiopancreatography; EUS, endoscopic ultrasound; EGD, esophagogastroduodenoscopy; CFS, colonoscopy; DBE, double-balloon enteroscopy.

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