Background and aims Non-Anesthesiologist-Administered Propofol (NAAP) is increasingly accepted, but there is limited data on drug administration via Target Controlled Infusion (TCI) in clinical practice. TCI adjusts drug infusion based on patient-specific parameters, maintaining a constant drug dose to reduce the risk of adverse events due to drug overdosing and enhance patient comfort. The aims of this study are to assess the rate of adverse events (AEs) and evaluate patient satisfaction with NAAP via TCI in a retrospective cohort of 18,302 procedures. Methods Sequential enrolment of low-risk patients (ASA score 1 and 2) undergoing outpatient gastrointestinal (GI) endoscopic procedures, including esophagogastroduodenoscopies (EGDs) and colonoscopies, at IRCCS San Raffaele Hospital (Milan, Italy) between May 2019 and November 2021. Results Data from 7,162 EGDs and 11,140 colonoscopies were analyzed. The median age was 59.1±14.8 years, median BMI 24.9 (3.7). Male-to-female ratio was equal to 8,798 (48.1%)/9,486 (51.9%). AEs occurred in 240 procedures (1.3%) out of the total cohort, with no differences between EGDs and colonoscopies (N=100, 1.4% and N=140, 1.2%, respectively, p=0.418). A total of 15,875 patients (98.9%) indicated they would likely repeat the procedure with the same sedation protocol. Age (OR 1.02 95% CI 1.01-1.03, p<0.008) was the only independent factor associated with overall AEs. Conclusions NAAP via TCI is an effective and safe sedation method for routine endoscopy. Proper propofol dosage based on individual patients and the presence of trained operators are crucial for NAAP sedation management. 

Safety and tolerability outcomes of non-anesthesiologist-administered propofol via target controlled infusion in routine gastrointestinal endoscopy.

Background Because the quality of anesthesia affects the surgical outcome, the aim of this study was to investigate the current status of anesthetic services performed by anesthesiologists and non-anesthesiologists in South Korea from 2014 to 2016 and to compare the results with data from 2011 to 2013. Methods The claimed anesthesia services at medical institutions with employed anesthesiologists and the claims for an invitation fee for an anesthesiologist at medical institutions without employed anesthesiologists were regarded as anesthetic services performed by an anesthesiologist. From 2014 to 2016, the employment of anesthesiologists according to the type of medical institution, the status of anesthetic services according to the presence or absence of employed anesthesiologists, and status of anesthetic services at medical institutions without employed anesthesiologists were analyzed. Results The proportion of medical institutions that employed anesthesiologists slightly increased from 27.8% in 2014 to 28.8% in 2016. General anesthesia was more concentrated at higher medical institutions, and most anesthesias were performed by an anesthesiologist. The proportion of spinal anesthesia, epidural anesthesia, and brachial plexus performed by non-anesthesiologists was 11%, 15%, and 16.5%, respectively. Intravenous anesthesia performed by non-anesthesiologists was 58% and has increased compared to the past. Conclusions The employment of anesthesiologists has increased with time, and general anesthesiology was mostly performed by anesthesiologists. However, since the proportion of anesthetic services performed by non-anesthesiologists in regional anesthesia and intravenous anesthesia was maintained high, it is necessary to find ways to expand the safety of anesthetic services.

https://ekja.org/upload/pdf/kja-22286.pdf

The state of anesthesia in South Korea: a national survey of the status of anesthetic service activity in 2014–2016

Polypectomy Considerations in Elderly Patients

Protocol and previous versions available via https://doi.org/10.1002/14651858.CD006268, and https://doi.org/10.1002/14651858.CD006268.pub2. 

Propofol for sedation during colonoscopy

Background and study aims Efficacy and safety of NAAP for gastrointestinal endoscopy have been widely documented, although there is no information about the outcomes of colonoscopy when the endoscopist supervises the sedation. In this context, the aim of this trial was to determine the equivalence of adenoma detection rate (ADR) in colorectal cancer (CRC) screening colonoscopies performed with non-anesthesiologist-administered propofol (NAAP) and performed with monitored anesthesia care (MAC). Patients and methods This was a single-blind, non-randomized controlled equivalence trial that enrolled adults from a national CRC screening program (CRCSP). Patients were blindly assigned to undergo either colonoscopy with NAAP or MAC. The main outcome measure was the ADR in CRCSP colonoscopies performed with NAAP. Results We included 315 patients per group. The median age was 59.76 ± 5.81 years; 40.5 % of patients were women. The cecal intubation rate was 97 %, 81.8 % of patients had adequate bowel preparation, withdrawal time was > 6 minutes in 98.7 %, and the median global exploration time was 24.25 ± 8.86 minutes (range, 8–70 minutes). The ADR was 62.9 % and the complication rate (CR) was 0.6 %. Analysis by intention-to-treat showed an ADR in the NAAP group of 64.13 % compared with 61.59 % in the MAC group, a difference (δADR) of 2.54 %, 95 %CI: −0.10 to 0.05. Analysis by per-protocol showed an ADR in the NAAP group of 62.98 %, compared with 61.94 % in the MAC group, δADR: 1.04 %, 95 %CI: −0.09 to 0.07. There was no difference in CR (NAAP: 0,63 vs. MAC: 0.63); P = 1.0. Conclusions ADR in colorectal cancer screening colonoscopies performed with NAAP was equivalent to that in those performed with MAC. Similarly, there was no difference in complication rates.

/pdf/outcomes-of-colonoscopy-with-non-anesthesiologist-3yqsufvkme.pdf

Outcomes of colonoscopy with non-anesthesiologist-administered propofol (NAAP): an equivalence trial.

Mo1700 RISK FACTORS FOR INCOMPLETE ENDOSCOPIC MUCOSAL RESECTION OF LARGE COLORECTAL POLYPS: PARIS IS-II

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Mo1700 RISK FACTORS FOR INCOMPLETE ENDOSCOPIC MUCOSAL RESECTION OF LARGE COLORECTAL POLYPS: PARIS IS-II

Outcomes of colonoscopy with non-anesthesiologist-administered propofol (NAAP): an equivalence trial.