Endoscopist-directed administration of propofol : a worldwide safety experience

Rex, Douglas K. and Deenadayalu, Viju P. and Eid, Emely and Imperiale, Thomas F. and Walker, John A. and Sandhu, Kuldip and Clarke, Anthony C. and Hillman, Lybus C. and Horiuchi, Akira and Cohen, Lawrence B. and Heuss, Ludwig T. and Peter, Shajan and Beglinger, Christoph and Sinnott, James A. and Welton, Thomas and Rofail, Magdy and Subei, Iyad and Sleven, Rodger and Jordan, Paul and Goff, John and Gerstenberger, Patrick D. and Munnings, Harold and Tagle, Martin and Sipe, Brian W. and Wehrmann, Till and Di Palma, Jack A. and Occhipinti, Kaitlin E. and Barbi, Egidio and Riphaus, Andrea and Amann, Stephen T. and Tohda, Gen and McClellan, Timothy and Thueson, Charles and Morse, John and Meah, Nizam. (2009) Endoscopist-directed administration of propofol : a worldwide safety experience. Gastroenterology, Vol. 137, H. 4 , S. 1229-1237 ; quiz 1518-1519.

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Official URL: http://edoc.unibas.ch/dok/A6007452

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BACKGROUND ; AIMS: Endoscopist-directed propofol sedation (EDP) remains controversial. We sought to update the safety experience of EDP and estimate the cost of using anesthesia specialists for endoscopic sedation. METHODS: We reviewed all published work using EDP. We contacted all endoscopists performing EDP for endoscopy that we were aware of to obtain their safety experience. These complications were available in all patients: endotracheal intubations, permanent neurologic injuries, and death. RESULTS: A total of 646,080 (223,656 published and 422,424 unpublished) EDP cases were identified. Endotracheal intubations, permanent neurologic injuries, and deaths were 11, 0, and 4, respectively. Deaths occurred in 2 patients with pancreatic cancer, a severely handicapped patient with mental retardation, and a patient with severe cardiomyopathy. The overall number of cases requiring mask ventilation was 489 (0.1%) of 569,220 cases with data available. For sites specifying mask ventilation risk by procedure type, 185 (0.1%) of 185,245 patients and 20 (0.01%) of 142,863 patients required mask ventilation during their esophagogastroduodenoscopy or colonoscopy, respectively (P > .001). The estimated cost per life-year saved to substitute anesthesia specialists in these cases, assuming they would have prevented all deaths, was $5.3 million. CONCLUSIONS: EDP thus far has a lower mortality rate than that in published data on endoscopist-delivered benzodiazepines and opioids and a comparable rate to that in published data on general anesthesia by anesthesiologists. In the cases described here, use of anesthesia specialists to deliver propofol would have had high costs relative to any potential benefit.
Faculties and Departments:03 Faculty of Medicine > Departement Biomedizin > Former Units at DBM > Gastroenterology (Beglinger)
UniBasel Contributors:Beglinger, Christoph
Item Type:Article, refereed
Article Subtype:Further Journal Contribution
Note:Publication type according to Uni Basel Research Database: Journal item
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Last Modified:20 Jun 2014 07:56
Deposited On:20 Jun 2014 07:56

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