Non-anesthesiologist administration of propofol for gastrointestinal endoscopy: European Society of Gastrointestinal Endoscopy, European Society of Gastroenterology and Endoscopy Nurses and Associates Guideline – Updated June 2015

Jean-Marc Dumonceau; Andrea Riphaus; Florian Schreiber; Peter Vilmann; Ulrike Beilenhoff; Jose R. Aparicio; John J. Vargo; Maria Manolaraki; Caroline Wientjes; István Rácz; Cesare Hassan; Gregorios Paspatis

doi:10.1055/s-0034-1393414

Endoscopy, Table of Contents

Endoscopy 2015; 47(12): 1175-1189
DOI: 10.1055/s-0034-1393414

Guideline

Non-anesthesiologist administration of propofol for gastrointestinal endoscopy: European Society of Gastrointestinal Endoscopy, European Society of Gastroenterology and Endoscopy Nurses and Associates Guideline – Updated June 2015

Jean-Marc Dumonceau

¹La Plata, Argentina

,

Andrea Riphaus

²Department of Medicine, Klinikum Agnes Karll, Laatzen, Germany

,

Florian Schreiber

³Department of Internal Medicine, Division of Gastroenterology and Hepatology, Medical University Graz, Graz, Austria

,

Peter Vilmann

⁴Gastro Unit, Division of Surgical Gastroenterology, Copenhagen University Hospital, Herlev, Denmark

,

Ulrike Beilenhoff

⁵European Society of Gastroenterology and Endoscopy Nurses and Associates (ESGENA), Scientific Secretary, Ulm, Germany

,

Jose R. Aparicio

⁶Endoscopy Unit, Hospital General Universitario de Alicante, Pintor Baeza s/n, Alicante, Spain

,

John J. Vargo

⁷Department of Gastroenterology and Hepatology, Cleveland Clinic Lerner College of Medicine of Case Western University, Cleveland, Ohio, USA

,

Maria Manolaraki

⁸Department of Anesthesiology, Benizelion General Hospital, L. Knossou, Heraklion, Crete, Greece

,

Caroline Wientjes

⁹Department of Gastroenterology, Sint Lucas Andreas Ziekenhuis, Amsterdam, The Netherlands

,

István Rácz

¹⁰First Department of Internal Medicine and Gastroenterology, Petz Aladar Hospital, Gyor, Vasvari, Hungary

,

Cesare Hassan

¹¹Gastroenterology Department, Nuovo Regina Margherita Hospital, Rome, Italy

,

Gregorios Paspatis

¹²Department of Gastroenterology, Benizelion General Hospital, L. Knossou, Heraklion, Crete, Greece

› Author Affiliations

Abstract

This Guideline is an official statement of the European Society of Gastrointestinal Endoscopy (ESGE) and the European Society of Gastroenterology and Endoscopy Nurses and Associates (ESGENA). It addresses the administration of propofol by non-anesthesiologists for gastrointestinal (GI) endoscopy.

Main Recommendations

1 We recommend that the type of endoscopic procedure and the patient’s American Society of Anesthesiologists (ASA) physical status, age, body mass index, Mallampati’s classification, and risk factors for obstructive sleep apnea (OSA) be assessed before each procedure with non-anesthesiologist administration of propofol (NAAP) (strong recommendation, moderate quality evidence).

2 We suggest primary involvement of an anesthesiologist in patients of ASA class ≥ 3, with a Mallampati’s class ≥ 3 or other conditions that put them at risk of airway obstruction (e. g. pharyngolaryngeal tumors), in patients who chronically receive significant amounts of narcotic analgesics, or in cases where a long-lasting procedure is anticipated (weak recommendation, low quality evidence).

3 We suggest consideration of capnographic monitoring during NAAP in specific situations including high risk patients, intended deep sedation, and long procedures (weak recommendation, high quality evidence).

4 We suggest propofol monotherapy except in particular situations (weak recommendation, high quality evidence).

5 We recommend administering propofol through intermittent bolus infusion or perfusor systems, including target-controlled infusion (TCI), and consideration of patient-controlled sedation (PCS) in particular situations (strong recommendation, high quality evidence).

6 We suggest that patients listen to self-selected music during upper and lower GI endoscopy procedures (weak recommendation, moderate quality evidence).

7 We do not suggest using pharyngeal anesthesia during propofol sedation for upper GI endoscopy (weak recommendation, moderate quality evidence).

8 We suggest using the post-anesthetic discharge scoring system (PADSS) to determine when patient recovery is sufficient to allow discharge (weak recommendation, low quality evidence).

9 Minimum discharge criteria should be fulfilled before discharging a patient. We recommend that patients who have received combined regimens, and all patients of ASA class > 2, should upon discharge be accompanied by a responsible person and refrain for 24 hours from driving, drinking alcohol, operating heavy machinery, or engaging in legally binding decisions. Advice should be provided verbally and in written form to the patient, including a 24-hour contact phone number (strong recommendation, low quality evidence).

10 For patients of ASA classes 1 – 2 who have received low dose propofol monotherapy, a 6-hour limit is suggested (weak recommendation, low quality evidence).

Full Text

References

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