The safety of deep sedation with propofol controlled by the endoscopist in endoscopic retrograde cholangiopancreatography

• Published in: Revista española de enfermedades digestivas Vol. 110; no. 4; p. 217
• Main Authors: Soria-San-Teodoro, Maria Teresa, Gimenez-Julvez, Teresa, Uribarrena-Amezaga, Rafael, Sierra-Moros, Eva Maria, Ollero-Domenche, Leticia, Luzon-Solanas, Lara, Val-Perez, Jose
• Format: Journal Article
• Language: Spanish
• Published: Sociedad Espanola de Patologia Digestivas 01.04.2018
• ISSN: 1130-0108

Introduction: propofol administered by an endoscopist with a trained nurse has evolved as an alternative to anesthesia monitoring and is increasingly common in the routine clinical practice, even in advanced endoscopy. Objective: to evaluate the safety of deep sedation with endoscopist-controlled propofol in patients undergoing endoscopic retrograde cholangiopancreatography (ERCP). Material and methods: this was a prospective study in patients undergoing ERCP under deep sedation with propofol. Different patient-related variables were included and the initial and final data on oxygen saturation (Sat[O.sub.2]), blood pressure (BP) and heart rate (HR) were recorded in order to determine the presence of adverse events due to sedation (hypoxemia, hypotension, or bradycardia). Results: a total of 661 patients underwent ERCP under sedation with propofol over a 24-month period. The rate of recorded adverse events was 9.7%. The most frequent adverse event was hypoxemia (5.7%), followed by bradycardia (2.4%) and hypotension (1.6%). According to the univariate analysis, the occurrence of adverse events due to sedation (AES) was associated with an ASA score > III (p = 0.026), older patients (p = 0.009), higher body mass index (BMI) (p = 0.002) and a longer exploration time (p = 0.034). The induction dose of propofol was also associated with a greater likelihood of adverse events (p = 0.045) but not the total dose of propofol administered (p = 0.153). According to the multivariate logistic regression analysis, age, body mass index (BMI) and the duration of the exploration were independent predictors of SAE (p < 0.05). Conclusion: deep sedation with propofol controlled by trained endoscopy staff is a safe method in complex endoscopic procedures such as ERCP Key words: Sedation. Propofol. ERCP Complications.