COMPARATIVE STUDY ON THE SAFETY OF NON-ANESTHESIOLOGIST ADMINISTERED PROPOFOL SEDATION IN COLORECTAL CANCER SCREENING COLONOSCOPY

Aims Non-anesthesiologist administered Propofol (NAAP) sedation in endoscopy has dramatically increased. However, NAAP safety must be assessed for each endoscopic procedure, as their characteristics are not comparable. We aimed to assess the safety of NAAP sedation in screening colonoscopy, a high-quality procedure, of higher complexity than standard colonoscopy.

Methods Prospective cohort study comparing midazolam, Propofol and combined sedation in colonoscopy screening performed in 2018 and 2019. We used ASA and Ramsay scales for comorbidities and sedation level. Cardiopulmonary adverse events (CPAE) were defined as systolic blood pressure<90 mmHg, oxygen saturation<90% or arrythmia.

Results We analysed 3200 screening colonoscopies (58.1% men), ASA-1 51.2%, ASA-2 39.6%, ASA-3-4 9.2%. Prior to sedation, 63 subjects (2%) showed cardiopulmonary abnormalities that would have been considered as CPAE (0.3%hypotension, 0.2% hypoxia, 1.5% bradycardia). Midazolam was used in 569 (17.8%), 1108 Propofol (34.6%) and 1525 combined (47.6%). Midazolam group showed higher opiod doses and lower Ramsay scores (p=0.000). 227 CPAES were registered in 205 colonoscopies (6.4%): hypotension (3.5%), hypoxia (1.4%), arrythmia (2.2%). Midazolam sedation group showed fewer CPAE (p=0.000). Propofol group showed more hypotension and bradycardia than combined (p=0.000). All CPAE were mild and resolved satisfactorily with simple manoeuvres ([Table 1]). Logistic regression model associated probability of no CPAE with midazolam sedation (p=0.000) and a short duration of colonoscopy (p=0.006).

Table 1

Hypotension TAS<90mmHg N=111	No intervention 15 (13.5%)	Saline solution 73 (65.7%)	Perfusion decrease 17 (15.3%)	Both 6 (5,4%)
Hypoxia Sat<90% N=46	No intervention 0	Chin-Forehead manoeuvre 37 (80.4%)	Perfusion decrease 8 (17.4%)	Ambu Ventilation 1 (2,2%)
Bradicardia FC<50-lpm N=70	No intervention 49 (70%)	Atropine 4 (5.7%)	Perfusion decrease 17 (24.3%)	Both 0

Conclusions The development of CPAE in screening colonoscopy seems tobe associated to Propofol sedation and long duration procedures.

CPAE severity is mild, and in most cases endoscopic team management can be considered satisfactory.

Publication History

Article published online:
14 April 2022