Gastroenterology
Volume 129, Issue 5 , Pages 1384-1391 , November 2005

Trained Registered Nurses/Endoscopy Teams Can Administer Propofol Safely for Endoscopy

  • Douglas K. Rex

      Affiliations

    • Division of Gastroenterology/Hepatology, Department of Medicine, Indiana University Hospital, Indianapolis, Indiana
    • Corresponding Author InformationAddress requests for reprints to: Douglas K. Rex, MD, Indiana University Hospital, #4100, 550 North University Boulevard, Indianapolis, Indiana 46202. fax: (317) 274-5449.
    • ,
  • Ludwig T. Heuss

      Affiliations

    • Division of Gastroenterology and Hepatology, University Hospital of Basel, Basel, Switzerland
    • ,
  • John A. Walker

      Affiliations

    • Gastroenterology Associates, Medford, Oregon
    • ,
  • Rong Qi

      Affiliations

    • Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana

Received 13 July 2005 ,Accepted 3 August 2005.

References 

  1. Lieberman DA , Weiss DG , Bond JH , Ahnen DJ , Garewal H , Chejfec G  Veterans Affairs Cooperative Study Group 380 . Use of colonoscopy to screen asymptomatic adults for colorectal cancer . N Engl J Med . 2000;343:162–168
  2. Imperiale TF , Wagner DR , Lin CY , Larkin GN , Rogge JD , Ransohoff DF . Risk of advanced proximal neoplasms in asymptomatic adults according to the distal colorectal findings . N Engl J Med . 2000;343:169–174
  3. Rex DK, Lehman GA, Hawes RH, Pound DC, Helper D, Ulbright TM, et al. Colonic neoplasia in asymptomatic persons; influence of age, gender and family history . Am J Gastroenterol . 1993;88:825–831
  4. Sampliner RE  Practice Parameters Committee of the American College of Gastroenterology . Updated guidelines for the diagnosis, surveillance, and therapy of Barrett’s esophagus . Am J Gastroenterol . 2002;97:1888–1895
  5. Hur C , Gazelle GS , Zalis ME , Podolsky DK . An analysis of the potential impact of computed tomographic colonography (virtual colonoscopy) on colonoscopy demand . Gastroenterology . 2004;127:1312–1321
  6. Zubarik R , Ganguly E , Benway D , Ferrentino N , Moses P , Vecchio J . Procedure-related abdominal discomfort in patients undergoing colorectal cancer screening (a comparison of colonoscopy and flexible sigmoidoscopy) . Am J Gastroenterol . 2002;97:3056–3061
  7. Faulx AL, Vela S, Das A, Cooper G, Isenberg G, Sivak MV, et al. A changing landscape of practice patterns regarding unsedated endoscopy and propofol use (a national survey) . (abstr) Gastrointest Endosc . 2004;59:AB131
  8. Sipe BW, Rex DK, Latinovich D, Overley C, Kinser K, Bratcher L, et al. Propofol versus midazolam/meperidine for outpatient colonoscopy (administration by nurses supervised by endoscopists) . Gastrointest Endosc . 2002;55:815–825
  9. Ulmer BJ, Hansen JJ, Overley CA, Symms MR, Chadalawada V, Liangpunsakul S, et al. Propofol versus midazolam/fentanyl for outpatient colonoscopy (administration by nurses supervised by endoscopists) . Clin Gastroenterol Hepatol . 2003;1:425–432
  10. Vargo JJ, Zuccaro G, Dumot JA, Shermock KM, Morrow JB, Conwell DL, et al. Gastroenterologist-administered propofol versus meperidine and midazolam for advanced upper endoscopy (a prospective, randomized trial) . Gastroenterology . 2002;123:8–16
  11. Dewitt J, Leblanc J, McHenry L, Sherman S, Baker J, Lee A, et al. Registered nurse-administered propofol sedation (RNAPS) versus midazolam and meperidine (MM) for endoscopic ultrasound (EUS) (a prospective, randomized trial (abstr)) . Gastrointest Endosc . 2003;57:AB78
  12. Walker JA, McIntyre RD, Schleinitz PF, Jacobson KN, Haulk AA, Adesman P, et al. Nurse-administered propofol sedation without anesthesia specialists in 9152 endoscopic cases in an ambulatory surgery center . Am J Gastroenterol . 2003;98:1744–1750
  13. Heuss LT , Schnieper P , Drewe J , Pflimlin E , Beglinger C . 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
  14. Rex DK, Overley C, Kinser K, Coates M, Lee A, Goodwin BW, et al. Safety of propofol administered by registered nurses with gastroenterologist supervision in 2000 endoscopic cases . Am J Gastroenterol . 2002;97:1159–1163
  15. Heuss LT , Schnieper P , Drewe J , Pflimlin E , Beglinger C . Conscious sedation with propofol in elderly patients (a prospective evaluation) . Aliment Pharmacol Ther . 2003;17:1493–1501
  16. Heuss LT , Schnieper P , Drewe J , Pflimlin E , Beglinger C . Safety of propofol for conscious sedation during endoscopic procedures in high-risk patients-a prospective, controlled study . Am J Gastroenterol . 2003;98:1751–1757
  17. Clarke AC , Chiragakis L , Hillman LC , Kaye GL . Sedation for endoscopy (the safe use of propofol by general practitioner sedationists) . Med J Aust . 2002;176:159–162
  18. Kongkam P , Pornphisarn B , Rerknimitr R . Non-anesthetist administered propofol for ERCP; efficacy, safety profile and side effect (a prospective randomized trial (abstr)) . Gastrointest Endosc . 2004;59:AB127
  19. Gonzalez-Huix F, Aldeguer X, Fort E, Salinas E, Figa M, Hombrados M, et al. Sedation without anesthesiologist in 5250 endoscopic procedures (midazolam vs. midazolam + dolantine vs. propofol) . (abstr). Gastrointest Endosc . 2004;59:AB133
  20. Külling D , Rothenbühler R , Inauen W . Safety of nonanesthetist sedation with propofol for outpatient colonoscopy and esophago-gastroduodenoscopy . Endoscopy . 2003;35:679–682
  21. Cohen LB , Hightower CD , Wood DA , Miller KM , Aisenberg J . Moderate level sedation during endoscopy (a prospective study using low-dose propofol, meperidine/fentanyl, and midazolam) . Gastrointest Endosc . 2004;59:795–803
  22. Vargo JJ , Eisen GM , Faigel DO , Holub J , Lieberman DA . Cardiopulmonary complications with non-anesthesiologist-administered propofol vs. standard sedation (the CORI experience (abstr)) . Gastrointest Endosc . 2005;59:AB132
  23. Koshy G , Nair S , Norkus EP , Hertan HI , Pitchumoni CS . Propofol versus midazolam and meperidine for conscious sedation in GI endoscopy . Am J Gastroenterol . 2000;95:1476–1479
  24. Yusoff IF , Raymond G , Sahal AV . Endoscopist administered propofol for upper-GI EUS is safe and effective (a prospective study in 500 patients) . Gastrointest Endosc . 2004;60:356–360
  25. Sinnott JA , Fricker EJ , Rogers A . Propofol/meperidine versus midazolam/meperidine (a one year comparison in a community based surgery center) . Am J Gastroenterol . 2004;99(Suppl):S303–S304
  26. Meah NM , Parikh PB . Efficacy and safety of nurse-administered propofol as an adjunctive agent of conscious sedation in private non-academic gastroenterology practice setting (abstr) . Am J Gastroenterol . 2004;99:S313
  27. AANA-ASA joint statement regarding propofol administration. April 14, 2004. Available at: http://www.asahq.org/news/propofolstatement.htm. Accessed September 26, 2005.
  28. Meltzer B. RNs pushing propofol. Available at: http://www.outpatientsurgery.net/2003/os07/rns_pushing_propofol.php. Accessed September 26, 2005.
  29. Fechner J, Ihmsen H, Hatterscheid D, Jeleazcov C, Schiessl C, Vornov JJ, et al. Comparative pharmacokinetics and pharmacodynamics of the new propofol prodrug GPI 15715 and propofol emulsion . Anesthesiology . 2004;101:626–639
  30. Practice guidelines for sedation and analgesia by non-anesthesiologists (An updated report by the American Society of Anesthesiologists Task Force on Sedation and Analgesia by Non-Anesthesiologists) . Anesthesiology . 2002;96:1004–1017
  31. Arrowsmith JB , Gerstman BB , Fleischer DE , Benjamin SB . Results from the American Society for Gastrointestinal Endoscopy/U.S . Food and Drug Administration collaborative study on complication rates and drug use during gastrointestinal endoscopy. Gastrointest Endosc . 1991;37:421–427
  32. Daneshmend TK , Bell GD , Logan RFA . Sedation for upper gastrointestinal endoscopy (results of a nationwide survey) . Gut . 1991;32:12–15
  33. Quine MA , Bell GD , McCloy RF , Charlton JE , Devlin HB , Hopkins A . Prospective audit of upper gastrointestinal endoscopy in two regions of England (safety, staffing, and sedation methods) . Gut . 1995;36:462–467
  34. Thompson AM , Wright DJ , Murray W , Ritchie GL , Burton HD , Stonebridge PA . Analysis of 153 deaths after upper gastrointestinal endoscopy (room for improvement?) . Surg Endosc . 2004;18:22–25
  35. Froehlich F , Gonvers JJ , Fried M . Conscious sedation, clinically relevant complications and monitoring of endoscopy (results of a nationwide survey in Switzerland) . Endoscopy . 1994;26:231–234
  36. Farrow SC , Fowkes FG , Lunn JN , Robertson IB , Samuel P . Epidemiology in anaesthesia. II: factors affecting mortality in hospital . Br J Anaesth . 1982;54:811–817
  37. Eichhorn JH . Prevention of intraoperative anesthesia accidents and related severe injury through safety monitoring . Anesthesiology . 1989;70: 572–527
  38. Warner MA , Shields SE , Chute CG . Major morbidity and mortality within 1 month of ambulatory surgery and anesthesia . JAMA . 1993;270:1437–1441
  39. Spence AA . The lessons of CEPOD . Br J Anaesth . 1988;60:753–754
  40. Lunn JN , Devlin HB . Lessons from the confidential enquiry into perioperative deaths in three NHS regions . Lancet . 1987;2:1384–1386
  41. Newland MC, Ellis SJ, Lydiatt CA, Peters KR, Tinker JH, Romberger DJ, et al. Anesthetic-related cardiac arrest and its mortality (a report covering 72,959 anesthetics over 10 years from a US teaching hospital) . Anesthesiology . 2002;97:108–115
  42. Kawashima Y, Takahashi S, Suzuki M, Morita K, Irita K, Iwao Y, et al. Anesthesia-related mortality and morbidity over a 5-year period in 2,363,038 patients in Japan . Acta Anaesthesiol Scand . 2003;47:809–817
  43. Arbous MS, Grobbee DE, van Kleef JW, de Lange JJ, Spoormans HH, Touw P, et al. Mortality associated with anaesthesia (a qualitative analysis to identify risk factors) . Anaesthesia . 2001;56:1141–1153
  44. Cohen MM , Duncan PG , Tate RB . Does anesthesia contribute to operative mortality? . JAMA . 1988;260:2859–2863

PII: S0016-5085(05)01635-5

doi: 10.1053/j.gastro.2005.08.014

Gastroenterology
Volume 129, Issue 5 , Pages 1384-1391 , November 2005

Article Tools