Why the study?
Does nonanesthesiologist-administered propofol provide safe and effective sedation compared to standard sedation in patients undergoing GI endoscopy?
Population
Patients undergoing GI endoscopy (EGD, colonoscopy, ERCP, EUS)
Comparison
Nonanesthesiologist-administered propofol… vs Standard sedation or monitored anesthesia care
Design
Guideline
Authors
Discussion
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Member takes
Implication
Supports nonanesthesiologist propofol as standard sedation for GI endoscopy; extends Level 1 evidence for safety and efficiency.
Study Design
Type
Systematic Review (n=460,651)
Multicenter
Yes
Structured PICO
Does nonanesthesiologist-administered propofol provide safe and effective sedation compared to standard sedation in patients undergoing GI endoscopy?
P
Population
460,651 cases of nonanesthesiologist-administered propofol for GI endoscopy from multiple countries, primarily in adults.
I
Intervention
Nonanesthesiologist-administered propofol (NAAP), including nurse-administered propofol sedation (NAPS) and balanced propofol sedation (BPS)
C
Comparator
Standard sedation (intravenous drugs, usually a benzodiazepine and an opioid) or monitored anesthesia care (MAC)
O
Outcome
Safety (rates of hypoxemia, bradycardia, hypotension, need for airway intervention, mortality)safety
Nonanesthesiologist-administered propofol for GI endoscopy is safe, provides faster induction and recovery, and is cost-effective compared to standard sedation.
Limitations
- Worldwide experience with NAAP during ERCP and EUS is insufficient to draw definitive conclusions.
- Cost-effectiveness conclusions were based on mathematical modeling rather than prospective trials.
- The number of mentored cases necessary to demonstrate competency is currently unknown.
Cite This Study
Vargo et al. (2009) conducted a systematic review in GI endoscopy (n=460,651). Nonanesthesiologist-administered propofol (NAAP) vs. Standard sedation was evaluated on Safety (deaths, permanent injuries, hypoxemia, bradycardia, need for airway intervention). Nonanesthesiologist-administered propofol for GI endoscopy demonstrated a high safety profile, with only 3 deaths reported across 460,651 cases, and resulted in shorter induction and recovery times.