Endoscopist-administered propofol: a retrospective safety study.

BACKGROUND Propofol is an anesthetic agent that is commonly used for conscious sedation. Propofol has advantages as a sedative agent for endoscopic procedures including rapid onset, short half-life and rapid recovery time. However, concerns exist regarding the potential for respiratory depression, hypotension, perforation due to deep sedation and the need for monitoring by an anesthetist. Propofol has been used under endoscopist supervision at the Stanton Territorial Hospital in Yellowknife, Northwest Territories since 1996 (approximately 7000 cases). METHODS A retrospective chart review of endoscopic procedures conducted at the Stanton Territorial Hospital between January 1996 and May 2007 was performed. A random sample of 680 procedures was reviewed from a total of 6396 procedures. RESULTS The mean (+/- SD) baseline systolic blood pressure (SBP) was 122.8+/-17.0 mmHg. The mean lowest SBP was 101.7+/-14.5 mmHg. The mean absolute drop in SBP was 21.1+/-16.7 mmHg, with a mean per cent drop of 16.3%+/-11.7%. Eighty-eight patients (12.9%) developed transient hypotension (SBP lower than 90 mmHg). All patients regained normal blood pressure spontaneously on repeated measurement. No patients required intravenous fluid resuscitation. The mean O2 saturation was 96.4%+/-2.1%. One patient (0.1%) transiently desaturated (O2 saturation 89%), but recovered spontaneously on repeat measurement with no intervention. No procedures were aborted for patient safety. There were no major complications, including perforation or death. There was one mucosal tear during nontherapeutic colonoscopy (0.1%). CONCLUSIONS Propofol can be safely administered in a community hospital setting under endoscopist supervision, with no additional support or monitoring.

背景 丙泊酚是一种常用于清醒镇静的麻醉剂。丙泊酚作为内镜操作的镇静剂具有一些优势，包括起效快、半衰期短以及恢复时间快。然而，人们担心它可能导致呼吸抑制、低血压、深度镇静引起的穿孔以及需要麻醉师进行监测。自1996年以来，在加拿大西北地区耶洛奈夫的斯坦顿地区医院，丙泊酚一直在内镜医师的监督下使用（约7000例）。 方法 对1996年1月至2007年5月在斯坦顿地区医院进行的内镜操作进行了回顾性病历审查。从总共6396例操作中随机抽取了680例进行审查。 结果 平均（±标准差）基线收缩压（SBP）为122.8 ± 17.0 mmHg。平均最低SBP为101.7 ± 14.5 mmHg。SBP的平均绝对下降值为21.1 ± 16.7 mmHg，平均百分比下降为16.3% ± 11.7%。88例患者（12.9%）出现短暂性低血压（SBP低于90 mmHg）。所有患者在重复测量时血压自发恢复正常。没有患者需要静脉补液复苏。平均氧饱和度为96.4% ± 2.1%。1例患者（0.1%）出现短暂性氧饱和度下降（氧饱和度89%），但在重复测量时未进行干预自发恢复。没有因患者安全问题而中止操作。没有发生重大并发症，包括穿孔或死亡。在非治疗性结肠镜检查过程中出现1例黏膜撕裂（0.1%）。 结论 在社区医院环境下，在内镜医师的监督下，丙泊酚可以安全使用，无需额外的支持或监测。