Published on 10-21-2013 04:34 PM
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Sedation for outpatient endoscopy procedures had similar outcomes when certified registered nurse anesthetists (CRNAs) managed the protocol with or without anesthesiologist supervision, a review of more than 100,000 patient records showed.
Overall adverse event rates were low, and none of the most common or serious adverse events occurred more often when CRNAs handled sedation by themselves or with an anesthesiologist.
"In a large ambulatory endoscopy center with more than 100,000 total procedures there were no differences in adverse outcomes using two different propofol sedation models -- CRNA-MD and CRNA alone," Murtaza Parekh, MD, of Raleigh Endoscopy Center in North Carolina, reported here at the American College of Gastroenterology meeting.
"In the end, MD supervision did not significantly impact safety outcomes with propofol in our ambulatory endoscopy center. These conclusions correlate [with previous studies] showing that propofol sedation is as safe, if not safer, than conscious sedation."
The study had its genesis in the growing use of propofol sedation during endoscopy procedures. Recent estimates suggest propofol sedation might account for a majority of endoscopy procedures by 2015, Parekh noted.
A Cochrane review published in 2008 and revised in 2011 showed that propofol sedation in colonoscopy procedures was associated with shorter recovery and discharge times as compared with procedures performed using opiates and benzodiazepines. Procedure time and complication rates did not differ by the type of sedation used. Moreover patient satisfaction was higher with propofol than with the other two sedation modalities.
A review of worldwide experience with propofol sedation during endoscopy showed that propofol sedation had a superior safety record as compared with opiates and benzodiazepines administered by endoscopists.
Several gastroenterology organizations published a position paper that showed similar safety with propofol and conventional sedation, shorter recovery times, and equivalent or improved patient satisfaction with propofol sedation.
"However, the elephant in the room is the warning in the propofol package insert, stating that it should only be administered by someone trained in the administration of general anesthesia. This presented a big quandary when my endoscopy group decided to use propofol sedation in 2008.
"We felt we had three options: an anesthesiologist in every room, a CRNA with anesthesiologist supervision, and a CRNA with a gastroenterologist in the room as the supervisor," Parekh said.
Parekh reported findings from a retrospective review of 106,000 ambulatory endoscopy procedures performed with propofol sedation from October 2008 through August 2013. They focused on two administration protocols: CRNA with anesthesiologist supervision versus CRNA alone (except for the gastroenterologist). Adverse events were documented from patient records and from follow-up telephone calls placed to each patient within 24 hours after the procedure.
There were 70,436 procedures done by a CRNA with anesthesiologist supervision and 36,483 by a CRNA alone. Except for the presence or absence of an anesthesiologist, the same propofol sedation protocol was used for