Gastroenterologist-administered propofol for therapeutic upper endoscopy with graphic assessment of respiratory activity: a case series

Background: Traditional methods of sedation and analgesia for advanced endo scopic procedures can be inadequate and frequently prolong recovery room ob servation. Propofol is a rapidly acting agent that produces an excellent hy pnotic state, but its use is typically limited to anesthesiologist-assisted cases because of the inadequacy of current monitoring standards to reliabl y detect early stages of respiratory depression. Methods: Ten patients undergoing advanced upper endoscopic procedures (endo scopic retrograde cholangiopancreatography, endoscopic ultrasound, esophage al stent placement) received a propofol infusion under the control of a sec ond qualified gastroenterologist with advanced cardiac life support skills. Graphic assessment of respiratory activity was made by using a sidestream carbon dioxide detecting cannula. Patient satisfaction was measured with a 100 mm visual analog scale. Recovery scores were measured by standardized s coring of discharge criteria. Results: Monitoring with graphic assessment of respiratory activity detecte d early phases of respiratory depression, resulting in a timely decrease in the propofol infusion without significant hypoxemia, hypercapnia, hypotens ion, or arrhythmias. Satisfaction scores were extremely high (median score 92 of 100) and 9 of 10 patients met discharge criteria at 15 minutes after discontinuation of the propofol infusion. Conclusions: With the use of monitoring by graphic assessment of respirator y activity, propofol infusion by a second qualified gastroenterologist for prolonged upper endoscopic procedures is safe and results in high levels of patient satisfaction with rapid recovery times.