Introduction Propofol is being increasingly used for sedation in endoscopic procedures in the US and across Europe, but experience within UK centres remains limited. Over the last few years there has been an anaesthetist covered dedicated propofol sedation endoscopy list at the Leicester General Hospital. The aim was to evaluate the propofol sedation service with respect to current practice and complication rates, with a view to expanding the service and developing appropriate guidelines for more effective use.
Methods Review of all endoscopic procedures using propofol for sedation over 8-months at the Leicester General Hospital. Data were collected for all relevant procedures from August 2008 to March 2009. Indication for propofol use was examined, type of procedure, dose of propofol, and significant complications evaluated.
Result 48 procedures were done using propofol sedation during Aug 2008–March 2009: 54% OGD; 33% Colonoscopy; 8% PEG; 4% FOS. The patients' age ranged from 21–78 years (mean 52), with 52% female and 48% male. Of these procedures 45% had no clear indication for the use of propofol, 35% had previously failed the procedure under “standard sedation”, 13% required therapeutic procedures, 8% had other relevant indications for propofol sedation as opposed to standard endoscopic sedation. Dose was documented in 31% of cases, with dose ranging from 120–600 mg propofol (mean 324 mg). 2/48 (4%) had respiratory compromise requiring airway support with bag and mask ventilation for a few minutes. There were 15 pending requests at the time of evaluation: 60% COL; 13% OGD+COL; 13% banding/dilatation; 7% OGD; 7% PEG. Patients' age range was 25–65 years (mean 49), 67% female and 33% male. In 60% requests there was no reason identified for rationale behind use of propofol, 27% had previously failed procedure under standard sedation, 7% were therapeutic, and 7% were for surveillance purposes.
Conclusion There is increasing demand for the use of propofol for sedation in endoscopic procedures within UHL NHS Trust. In our centre there has been effective use of anaesthetist led propofol endoscopy lists with minimal complications and a good level of patient satisfaction. With increasing patient popularity and a greater drive for surveillance and screening procedures in patients, perhaps a formal anaesthetist supported propofol endoscopy service should be established in all endoscopy units. Until more information is available on the safety of use of propofol for diagnostic and therapeutic endoscopy, clear guidelines need to be in place in centres developing a propofol endoscopy service to ensure safe and appropriate use.
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