Haider Ali Khan1, Muhammad Umar2, Hamama Tul-Bushra1, Gul Nisar1, Muhammad Bilal3, Shifa Umar4. 1. Center for Liver and Digestive Diseases, Holy Family Hospital, F-block Satellite Town, Rawalpindi 46000, Pakistan. 2. Center for Liver and Digestive Diseases, Holy Family Hospital, F-block Satellite Town, Rawalpindi 46000, Pakistan. Electronic address: drumarpk@yahoo.com. 3. Army Medical College, Rawalpindi, Pakistan. 4. Shifa International Hospital, Islamabad, Pakistan.
Abstract
BACKGROUND AND STUDY AIMS: Propofol is increasingly being used for sedation purposes during endoscopic retrograde cholangiopancreatography (ERCP). This study aimed to evaluate the safety of non-anaesthesiologist administration of propofol (NAAP) during therapeutic ERCP. PATIENTS AND METHODS: Patients, who underwent ERCP at Centre for Liver and Digestive Diseases, Holy Family Hospital, Rawalpindi, were included in the study. Propofol sedation was administered by a physician who was a non-anaesthesiologist certified in basic and advanced cardiac life support. The total study duration was 6 months. The primary outcome variable was the frequency of any sedation-related complication. RESULTS: A total of 156 patients (41% males and 59% females) were enrolled in the study. The mean propofol dose used during the procedure was 201±132 mg. The mean propofol dose, when adjusted to weight and duration of procedure, was 0.05±0.04 mg kg(-1)min(-1). According to the American Society of Anesthesiologists (ASA) classification, 136 (87%) patients were placed in ASA class I and II and 20 (13%) patients were of ASA class III. Only two patients developed sedation-related complication: one minor requiring bag-mask ventilation and other major requiring mechanical ventilation via endotracheal intubation. Both were managed by the trained non-anaesthesiologist and gastroenterologist at the place of procedure. No patients required cardiopulmonary resuscitation and admission to the intensive care unit. There were no sedation-related deaths. CONCLUSION: NAAP sedation can be considered safe for low-risk patients (ASA class I and II) undergoing ERCP. The presence of a trained anaesthetist is advisable in high-risk patients (ASA class III and higher) with significant co-morbidities.
BACKGROUND AND STUDY AIMS: Propofol is increasingly being used for sedation purposes during endoscopic retrograde cholangiopancreatography (ERCP). This study aimed to evaluate the safety of non-anaesthesiologist administration of propofol (NAAP) during therapeutic ERCP. PATIENTS AND METHODS: Patients, who underwent ERCP at Centre for Liver and Digestive Diseases, Holy Family Hospital, Rawalpindi, were included in the study. Propofol sedation was administered by a physician who was a non-anaesthesiologist certified in basic and advanced cardiac life support. The total study duration was 6 months. The primary outcome variable was the frequency of any sedation-related complication. RESULTS: A total of 156 patients (41% males and 59% females) were enrolled in the study. The mean propofol dose used during the procedure was 201±132 mg. The mean propofol dose, when adjusted to weight and duration of procedure, was 0.05±0.04 mg kg(-1)min(-1). According to the American Society of Anesthesiologists (ASA) classification, 136 (87%) patients were placed in ASA class I and II and 20 (13%) patients were of ASA class III. Only two patients developed sedation-related complication: one minor requiring bag-mask ventilation and other major requiring mechanical ventilation via endotracheal intubation. Both were managed by the trained non-anaesthesiologist and gastroenterologist at the place of procedure. No patients required cardiopulmonary resuscitation and admission to the intensive care unit. There were no sedation-related deaths. CONCLUSION:NAAP sedation can be considered safe for low-risk patients (ASA class I and II) undergoing ERCP. The presence of a trained anaesthetist is advisable in high-risk patients (ASA class III and higher) with significant co-morbidities.
Authors: Basavana Goudra; Ahmad Nuzat; Preet M Singh; Gowri B Gouda; Augustus Carlin; Amit K Manjunath Journal: Saudi J Gastroenterol Date: 2015 Nov-Dec Impact factor: 2.485