Endoscopist-Directed Administration of Propofol: A Worldwide Safety Experience

Douglas K. Rex, Viju P. Deenadayalu, Emely Eid, Thomas F. Imperiale, John A. Walker, Kuldip Sandhu, Anthony C. Clarke, Lybus C. Hillman, Akira Horiuchi, Lawrence B. Cohen, Ludwig T. Heuss, Shajan Peter, Christoph Beglinger, James A. Sinnott, Thomas Welton, Magdy Rofail, Iyad Subei, Rodger Sleven, Paul Jordan, John GoffPatrick D. Gerstenberger, Harold Munnings, Martin Tagle, Brian W. Sipe, Till Wehrmann, Jack A. Di Palma, Kaitlin E. Occhipinti, Egidio Barbi, Andrea Riphaus, Stephen T. Amann, Gen Tohda, Timothy McClellan, Charles Thueson, John Morse, Nizam Meah

Research output: Contribution to journalArticle

299 Citations (Scopus)

Abstract

Background & Aims: Endoscopist-directed propofol sedation (EDP) remains controversial. We sought to update the safety experience of EDP and estimate the cost of using anesthesia specialists for endoscopic sedation. Methods: We reviewed all published work using EDP. We contacted all endoscopists performing EDP for endoscopy that we were aware of to obtain their safety experience. These complications were available in all patients: endotracheal intubations, permanent neurologic injuries, and death. Results: A total of 646,080 (223,656 published and 422,424 unpublished) EDP cases were identified. Endotracheal intubations, permanent neurologic injuries, and deaths were 11, 0, and 4, respectively. Deaths occurred in 2 patients with pancreatic cancer, a severely handicapped patient with mental retardation, and a patient with severe cardiomyopathy. The overall number of cases requiring mask ventilation was 489 (0.1%) of 569,220 cases with data available. For sites specifying mask ventilation risk by procedure type, 185 (0.1%) of 185,245 patients and 20 (0.01%) of 142,863 patients required mask ventilation during their esophagogastroduodenoscopy or colonoscopy, respectively (P <.001). The estimated cost per life-year saved to substitute anesthesia specialists in these cases, assuming they would have prevented all deaths, was $5.3 million. Conclusions: 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. In the cases described here, use of anesthesia specialists to deliver propofol would have had high costs relative to any potential benefit.

Original languageEnglish
Pages (from-to)1229-1237
Number of pages9
JournalGastroenterology
Volume137
Issue number4
DOIs
Publication statusPublished - Oct 2009

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Propofol
Safety
Masks
Nervous System Trauma
Intratracheal Intubation
Anesthesia
Costs and Cost Analysis
Digestive System Endoscopy
Colonoscopy
Disabled Persons
Benzodiazepines
Pancreatic Neoplasms
Cardiomyopathies
Intellectual Disability
General Anesthesia
Opioid Analgesics
Endoscopy
Mortality

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Rex, D. K., Deenadayalu, V. P., Eid, E., Imperiale, T. F., Walker, J. A., Sandhu, K., ... Meah, N. (2009). Endoscopist-Directed Administration of Propofol: A Worldwide Safety Experience. Gastroenterology, 137(4), 1229-1237. https://doi.org/10.1053/j.gastro.2009.06.042

Endoscopist-Directed Administration of Propofol : A Worldwide Safety Experience. / Rex, Douglas K.; Deenadayalu, Viju P.; Eid, Emely; Imperiale, Thomas F.; Walker, John A.; Sandhu, Kuldip; Clarke, Anthony C.; Hillman, Lybus C.; Horiuchi, Akira; Cohen, Lawrence B.; Heuss, Ludwig T.; Peter, Shajan; Beglinger, Christoph; Sinnott, James A.; Welton, Thomas; Rofail, Magdy; Subei, Iyad; Sleven, Rodger; Jordan, Paul; Goff, John; Gerstenberger, Patrick D.; Munnings, Harold; Tagle, Martin; Sipe, Brian W.; Wehrmann, Till; Di Palma, Jack A.; Occhipinti, Kaitlin E.; Barbi, Egidio; Riphaus, Andrea; Amann, Stephen T.; Tohda, Gen; McClellan, Timothy; Thueson, Charles; Morse, John; Meah, Nizam.

In: Gastroenterology, Vol. 137, No. 4, 10.2009, p. 1229-1237.

Research output: Contribution to journalArticle

Rex, DK, Deenadayalu, VP, Eid, E, Imperiale, TF, Walker, JA, Sandhu, K, Clarke, AC, Hillman, LC, Horiuchi, A, Cohen, LB, Heuss, LT, Peter, S, Beglinger, C, Sinnott, JA, Welton, T, Rofail, M, Subei, I, Sleven, R, Jordan, P, Goff, J, Gerstenberger, PD, Munnings, H, Tagle, M, Sipe, BW, Wehrmann, T, Di Palma, JA, Occhipinti, KE, Barbi, E, Riphaus, A, Amann, ST, Tohda, G, McClellan, T, Thueson, C, Morse, J & Meah, N 2009, 'Endoscopist-Directed Administration of Propofol: A Worldwide Safety Experience', Gastroenterology, vol. 137, no. 4, pp. 1229-1237. https://doi.org/10.1053/j.gastro.2009.06.042
Rex DK, Deenadayalu VP, Eid E, Imperiale TF, Walker JA, Sandhu K et al. Endoscopist-Directed Administration of Propofol: A Worldwide Safety Experience. Gastroenterology. 2009 Oct;137(4):1229-1237. https://doi.org/10.1053/j.gastro.2009.06.042
Rex, Douglas K. ; Deenadayalu, Viju P. ; Eid, Emely ; Imperiale, Thomas F. ; Walker, John A. ; Sandhu, Kuldip ; Clarke, Anthony C. ; Hillman, Lybus C. ; Horiuchi, Akira ; Cohen, Lawrence B. ; Heuss, Ludwig T. ; Peter, Shajan ; Beglinger, Christoph ; Sinnott, James A. ; Welton, Thomas ; Rofail, Magdy ; Subei, Iyad ; Sleven, Rodger ; Jordan, Paul ; Goff, John ; Gerstenberger, Patrick D. ; Munnings, Harold ; Tagle, Martin ; Sipe, Brian W. ; Wehrmann, Till ; Di Palma, Jack A. ; Occhipinti, Kaitlin E. ; Barbi, Egidio ; Riphaus, Andrea ; Amann, Stephen T. ; Tohda, Gen ; McClellan, Timothy ; Thueson, Charles ; Morse, John ; Meah, Nizam. / Endoscopist-Directed Administration of Propofol : A Worldwide Safety Experience. In: Gastroenterology. 2009 ; Vol. 137, No. 4. pp. 1229-1237.
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author = "Rex, {Douglas K.} and Deenadayalu, {Viju P.} and Emely Eid and Imperiale, {Thomas F.} and Walker, {John A.} and Kuldip Sandhu and Clarke, {Anthony C.} and Hillman, {Lybus C.} and Akira Horiuchi and Cohen, {Lawrence B.} and Heuss, {Ludwig T.} and Shajan Peter and Christoph Beglinger and Sinnott, {James A.} and Thomas Welton and Magdy Rofail and Iyad Subei and Rodger Sleven and Paul Jordan and John Goff and Gerstenberger, {Patrick D.} and Harold Munnings and Martin Tagle and Sipe, {Brian W.} and Till Wehrmann and {Di Palma}, {Jack A.} and Occhipinti, {Kaitlin E.} and Egidio Barbi and Andrea Riphaus and Amann, {Stephen T.} and Gen Tohda and Timothy McClellan and Charles Thueson and John Morse and Nizam Meah",
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T2 - A Worldwide Safety Experience

AU - Rex, Douglas K.

AU - Deenadayalu, Viju P.

AU - Eid, Emely

AU - Imperiale, Thomas F.

AU - Walker, John A.

AU - Sandhu, Kuldip

AU - Clarke, Anthony C.

AU - Hillman, Lybus C.

AU - Horiuchi, Akira

AU - Cohen, Lawrence B.

AU - Heuss, Ludwig T.

AU - Peter, Shajan

AU - Beglinger, Christoph

AU - Sinnott, James A.

AU - Welton, Thomas

AU - Rofail, Magdy

AU - Subei, Iyad

AU - Sleven, Rodger

AU - Jordan, Paul

AU - Goff, John

AU - Gerstenberger, Patrick D.

AU - Munnings, Harold

AU - Tagle, Martin

AU - Sipe, Brian W.

AU - Wehrmann, Till

AU - Di Palma, Jack A.

AU - Occhipinti, Kaitlin E.

AU - Barbi, Egidio

AU - Riphaus, Andrea

AU - Amann, Stephen T.

AU - Tohda, Gen

AU - McClellan, Timothy

AU - Thueson, Charles

AU - Morse, John

AU - Meah, Nizam

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N2 - Background & Aims: Endoscopist-directed propofol sedation (EDP) remains controversial. We sought to update the safety experience of EDP and estimate the cost of using anesthesia specialists for endoscopic sedation. Methods: We reviewed all published work using EDP. We contacted all endoscopists performing EDP for endoscopy that we were aware of to obtain their safety experience. These complications were available in all patients: endotracheal intubations, permanent neurologic injuries, and death. Results: A total of 646,080 (223,656 published and 422,424 unpublished) EDP cases were identified. Endotracheal intubations, permanent neurologic injuries, and deaths were 11, 0, and 4, respectively. Deaths occurred in 2 patients with pancreatic cancer, a severely handicapped patient with mental retardation, and a patient with severe cardiomyopathy. The overall number of cases requiring mask ventilation was 489 (0.1%) of 569,220 cases with data available. For sites specifying mask ventilation risk by procedure type, 185 (0.1%) of 185,245 patients and 20 (0.01%) of 142,863 patients required mask ventilation during their esophagogastroduodenoscopy or colonoscopy, respectively (P <.001). The estimated cost per life-year saved to substitute anesthesia specialists in these cases, assuming they would have prevented all deaths, was $5.3 million. Conclusions: 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. In the cases described here, use of anesthesia specialists to deliver propofol would have had high costs relative to any potential benefit.

AB - Background & Aims: Endoscopist-directed propofol sedation (EDP) remains controversial. We sought to update the safety experience of EDP and estimate the cost of using anesthesia specialists for endoscopic sedation. Methods: We reviewed all published work using EDP. We contacted all endoscopists performing EDP for endoscopy that we were aware of to obtain their safety experience. These complications were available in all patients: endotracheal intubations, permanent neurologic injuries, and death. Results: A total of 646,080 (223,656 published and 422,424 unpublished) EDP cases were identified. Endotracheal intubations, permanent neurologic injuries, and deaths were 11, 0, and 4, respectively. Deaths occurred in 2 patients with pancreatic cancer, a severely handicapped patient with mental retardation, and a patient with severe cardiomyopathy. The overall number of cases requiring mask ventilation was 489 (0.1%) of 569,220 cases with data available. For sites specifying mask ventilation risk by procedure type, 185 (0.1%) of 185,245 patients and 20 (0.01%) of 142,863 patients required mask ventilation during their esophagogastroduodenoscopy or colonoscopy, respectively (P <.001). The estimated cost per life-year saved to substitute anesthesia specialists in these cases, assuming they would have prevented all deaths, was $5.3 million. Conclusions: 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. In the cases described here, use of anesthesia specialists to deliver propofol would have had high costs relative to any potential benefit.

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