Safety of propofol administered by registered nurses with gastroenterologist supervision in 2000 endoscopic cases

Abstract

OBJECTIVES: Propofol has certain advantages over benzodiazepines plus narcotics as sedation for endoscopy. In a few centers, propofol has reportedly been used in endoscopic procedures and administered by nurses supervised by gastroenterologists without attendance by anesthesiologists or nurse anesthetists. METHODS: As part of our continuous quality improvement program, we prospectively recorded the doses of propofol and adverse reactions to the drug in our initial 2000 cases. In all cases propofol was administered by nurses who were supervised by gastroenterologists, with no involvement by an anesthesia specialist. RESULTS: The 2000 cases included 2222 procedures. There were five episodes of oxygen desaturation to <85%, four of which seemed to be related to excessive administration of propofol and were treated by brief (< 1 min) periods of mask ventilation. No patient required endotracheal intubation or hospital admission, or suffered long-term sequelae from propofol administration. There were no perforations in 977 colonoscopies. CONCLUSIONS: Propofol can be given safely by appropriately trained nurses under supervision by endoscopists. Technology that allows immediate detection of apnea would likely further improve its safety.