Non-anesthesiologist-administered propofol sedation for gastrointestinal endoscopy in ASA III patients: Eight-year experience

Background and study aims: Sedation in gastrointestinal endoscopy is widely recognized for improving patient comfort, procedure quality, and endoscopist satisfaction. Although non-anesthesiologist-administered sedation (NAS) with propofol is well established for low-risk patients (i.e. American Society of Anesthesiologist ASA I-II), evidence for its safety in higher-risk populations remains limited. The aim of this study was to evaluate safety of NAS with propofol in ASA III patients undergoing diagnostic gastrointestinal endoscopy. Patients and methods: This observational study included ASA III patients who underwent elective gastroscopy or colonoscopy under NAS with propofol, with or without adjunctive midazolam and/or fentanyl, between 2017 and 2024. Sedation was administered by trained endoscopy personnel according to European Society of Gastrointestinal Endoscopy/European Society of Gastroenterology and Endoscopy Nurses and Associates guidelines. Anesthesia-related adverse events (ARAEs) were categorized as minor, moderate, or severe based on World Society of Intravenous Anesthesia definitions. Secondary outcomes included identification of potential risk factors for ARAEs. Results: Among 1423 procedures (43.4% gastroscopies,56.6% colonoscopies), overall incidence of ARAEs was 5.2% (3.9% minor, 0.9% moderate, 0.4% severe), with no tracheal intubations or deaths. Hypotension (3.6%) was the most frequent and all such events were transient and reversible. Severe ARAEs were all bradycardia, successfully treated with atropine administration. The ARAE rate was higher with propofol + midazolam (8.6%) than with propofol + fentanyl (3.7%, P = 0.04). Logistic regression analysis identified lower body mass index as the only independent predictor of ARAEs (P Conclusions: NAS with propofol appears safe and feasible in ASA III patients when performed by trained staff following standardized protocols and monitoring. These findings support expanding NAS with propofol to higher-risk populations, optimizing resources and access to endoscopic care.