REGISTERED NURSE-ADMINISTERED SEDATION WITH PROPOFOL IN PATIENTS UNDERGOING ENDOSCOPIC ULTRASONOGRAPHY (USE): PROSPECTIVE ANALYSIS

Aims:

To analyze the safety profile of supervised nurse-administered sedation with propofol in monotherapy in a cohort of patients undergoing USE in a hospital tertiary.

Methods:

Prospective observational study (October 2015 – October 2016) of patients derived for USE, sedated with propofol in monotherapy by nursing supervised by the endoscopist according to a hospital protocol. Basal analysis: clinical background, medications, smoking, BMI, ASA and Mallampati. Basal registry, during the procedure and final: blood pressure, heart rate, O2 saturation, capnography, administered dosing, procedure length. Record of adverse events until the discharge of the patient from the endoscopy unit.

Results:

n = 174 patients were included: age 61 ± 15 y; ♂ 65% ♀ 34%; median IMC 25.4 (normal 51.1%; overweight 36.3%; obesity 12.6%); ASA I 14.2%; II 53.3%; III 32.5%; Mallampati 1/2 (67.6%) Vs 3/4 (32.4%). Propofol dosing (mg): Total 393 ± 180 (115 – 1200); Induction 173 ± 69 (50 – 450); Perfusion 220 ± 144 (0 – 893); Duration 30 ± 17 min (9 – 90); No differences were observed between hemodynamic parameters at the beginning/end of the procedure. There were 27/174 (15.5%) hiposaturation episodes < 90% (56.5% ASAI/II Vs 43.5% ASAIII) and 8/174 (0.4%) < 85%. All were reversed by cervical hyperextension (8/27 additional Guedel) until O2 saturation basal levels. No addicional ventilation technique nor endotracheal intubation was required. There were no associated cardiovascular events or related mortality. Obesity was significantly associated with O2 hyposaturations < 90 (p = 0.016) and active smoking with O2 hyposaturations < 85% (p = 0.005). The ASA (I/II Vs III), Mallampati (1/2 Vs 3/4), duration of procedure or propofol dosing did not present differences in this series.

Conclusions:

• In patients undergoing USE, obesity and active smoking are risk factors for hypoxemia during sedation with propofol.

• Propofol administration in monotherapy by trained, supervised nursing personnel it is feasible, safe and effective.