Endoscopy 2006; 38(7): 684-689
DOI: 10.1055/s-2006-925374
Original Article
© Georg Thieme Verlag KG Stuttgart · New York

Efficacy and safety of nurse-administered propofol sedation during emergency upper endoscopy for gastrointestinal bleeding: a prospective study

G.  Tohda1 , S.  Higashi1 , H.  Sakumoto1 , K.  Sumiyoshi1 , T.  Kane1
  • 1Department of Gastroenterology, Yujin Yamazaki Hospital, Hikone, Shiga, Japan
Further Information

Publication History

Submitted 18 November 2005

Accepted after revision 23 January 2006

Publication Date:
06 June 2006 (online)

Background and study aims: Recent studies have documented the safety of propofol sedation for endoscopic procedures, but many endoscopists are reluctant to use propofol for high-risk patients because of adverse effects. The aim of this study was to demonstrate the safety and efficacy of nurse-administered propofol sedation during emergency upper endoscopy for patients with gastrointestinal bleeding.
Patients and methods: Over a period of 18 months, 120 patients suffering from acute upper gastrointestinal bleeding received propofol sedation administered by a registered nurse. Among these, 15 patients were classified into American Society of Anesthesiologists (ASA) class IV, 84 were ASA class III, and 21 were ASA class II. Patients without gastrointestinal bleeding, who also received propofol during the same period and were matched for age, gender, and ASA class, served as controls.
Results: Endoscopic hemostasis was achieved in 98.3 % of patients, and 97.5 % were satisfied with the procedure. In patients with gastrointestinal bleeding, the rates of hypotension (systolic blood pressure < 90 mmHg) and hypoxemia (peripheral oxygen saturation < 90 %) were 8.3 % and 6.7 % respectively, values higher than those in the control group. However, neither mask ventilation nor endotracheal intubation was necessary. Although two patients with gastrointestinal bleeding developed pneumonia, most likely due to aspiration during the procedure, they recovered within 5 days of treatment. There were no sedation-associated severe complications or mortalities.
Conclusion: Using a strict protocol designed to protect the patient’s airway and cardiovascular function, nurse-administered propofol sedation during emergency upper gastrointestinal endoscopy is safe and appropriate in cases of acute gastrointestinal bleeding.

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G. Tohda, M. D.

Department of Gastroenterology

Yujin Yamazaki Hospital · 80 Takegahana-cho · Hikone 522-0044 · Japan

Fax: +81-749-231928

Email: genkipapa178@yahoo.co.jp