Manuel Bronstein

Sedation with propofol in digestive endoscopy administered by gastroenterologists. Experience in a Venezuelan hospital

espanolObjetivos: el propofol es un hipnotico de accion rapida que esta convirtiendose a nivel mundial en el farmaco de eleccion para la sedacion en endoscopia digestiva. Hay cierta controversia en relacion a su uso por medicos que no son anestesiologos. Presentamos nuestra experiencia en la administracion de propofol por endoscopistas y su personal de enfermeria. Metodos: estudio retrospectivo. Para la sedacion en endoscopia se utilizo exclusivamente propofol, administrado por el endoscopista que realizaba el procedimiento y su personal de enfermeria. Todos los pacientes incluidos eran de bajo y moderado riesgo quirurgico (ASA I, II y III). No se utilizo medicacion complementaria como benzodiacepinas u opiaceos. Resultados: se incluyeron un total de 70.696 procedimientos de endoscopia digestiva realizados entre los anos 2002 y 2017. Se administro propofol en un bolus de induccion de 10 a 50 mg continuando con bolus intermitentes de 10 a 20 mg, de acuerdo a la respuesta del paciente. La incidencia de complicaciones fue muy baja, requiriendose ventilacion asistida con mascara en 78 (0,11%) ocasiones. Solo un caso requirio intubacion endotraqueal y dos pacientes presentaron hipotension importante, por lo que precisaron la administracion de efedrina. El tiempo de recuperacion promedio de todas las funciones neuropsicomotoras posterior al procedimiento fue de 15 minutos. El 98% de los pacientes refirieron como bueno o excelente el nivel de tolerancia y recordaron con claridad los detalles de la entrevista realizada una hora despues del procedimiento. Conclusiones: el uso del propofol como sedante en endoscopia digestiva administrado y controlado por el endoscopista y su personal de enfermeria, en pacientes debidamente seleccionados, es una tecnica segura y eficaz que permite a los gastroenterologos lograr sedaciones adecuadas. EnglishObjectives: propofol is a rapid acting hypnotic that is becoming the drug of choice for sedation in digestive endoscopy worldwide. There is some controversy with regard to the use of propofol by physicians who are not anesthesiologists. We present our experience of the administration of propofol by endoscopist and nursing personnel. Methods: this was a retrospective study of sedation in endoscopy. Propofol was exclusively used and administered by the endoscopist who performed the procedure and the nursing staff. All patients included were of a low and moderate surgical risk (ASA I, II and III). No complementary medication was used such as benzodiazepines or opiates. Results: a total of 70,696 digestive endoscopy procedures performed between 2002 and 2017 were included in the study. Propofol was administered in an induction bolus of 10 to 50 mg, continuing with intermittent boluses of 10 to 20 mg, according to the patients’ response. The incidence of complications was very low, assisted ventilation with a mask was required on 78 (0.11%) occasions. Only one case required endotracheal intubation and two patients had significant hypotension that required the administration of ephedrine. The average recovery time of all neuropsychomotor functions after the procedure was 15 minutes; 98% of patients reported a good or excellent level of tolerance and clearly remembered the details of the interview one hour after the procedure. Conclusions: the use of propofol as a sedative in digestive endoscopy is a safe and effective technique, provided that it is administered and controlled by the endoscopist and nursing staff in properly selected patients. This allows gastroenterologists to achieve adequate sedation.