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Endoscopists can safely sedate patients with propofol during gastroenterological procedures, according to a study in the October issue of Gastroenterology

Douglas K. Rex, M.D., from the Indiana University Medical Center in Indianapolis, and colleagues reviewed 646,080 published and unpublished cases of endoscopist-directed propofol sedation (EDP) to determine its safety and estimate the cost of using anesthesia specialists.

The researchers found 11 cases of endotracheal intubations, no cases of permanent neurologic injuries, and four deaths. Mask ventilation was required in 0.1 percent of the 569,220 cases with data available during procedures including esophagogastroduodenoscopy or colonoscopy. Substituting anesthesia specialists would have cost $5.3 million per life-year saved, assuming they would have prevented all deaths.

"EDP thus far has a lower mortality rate than that in published data on endoscopist-delivered benzodiazepines and opioids and a comparable rate to that in published data on general anesthesia by anesthesiologists," Rex and colleagues conclude. "In the cases described here, use of anesthesia specialists to deliver propofol would have had high costs relative to any potential benefit."

Source: ModernMedicine

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