Nurse Administered Propofol Sedation (NAPS) versus On-call Anesthesiologist Administered Propofol Sedation (OAPS) in Elective Colonoscopy

Abstract

Background and Aims: As on-call anesthesiologist administered propofol sedation (OAPS) is costly and not readily available in all endoscopy units, endoscopy nurse administered propofol sedation (NAPS) can be an effective alternative. This study aimed to compare the dosage of propofol used by NAPS versus OAPS, cardiopulmonary adverse events and recovery time in low risk patients undergoing outpatient elective colonoscopy. Methods: A retrospective propensity score-matched cohort study was conducted. Electronic medical records of elective colonoscopies performed by 3 experienced endoscopists from January 2016 to December 2019 were retrieved. OAPSs were performed by 10 certified anesthesiologists while NAPSs were performed by 8 experienced registered endoscopy nurses. Baseline characteristics, performing endoscopist, cecal intubation time, withdrawal time, propofol dosage per procedure, and adverse events were collected and analyzed using 3:1 (NAPS:OAPS) propensity score matching by age, performing endoscopist and difficulty of colonoscopy as co-variates with standardized mean deviation of <0.1. Results: 278 eligible patients were included. After propensity score matching, there were 189 patients in NAPS and 63 in OAPS group for analysis. Demographic data were not different between the two groups. All procedures were technically successful with no difference in cecal intubation time (6.0±4 min vs 6.8±4 min; p=0.13) or total procedural time (17.2±16 min vs 16.3±6 min; p=0.66). Propofol dosage/kg/hour were significantly lower in the NAPS group, (11.4±4 mg/kg/hour vs. 16.6±8 mg/kg/hour; p<0.001). There were less minor cardiopulmonary adverse events in NAPS when compared to the OAPS group (2.2% vs 4.7%; p=0.014). Conclusions: NAPS in elective colonoscopy in low-risk patients is as effective as OAPS but requires a significant lower dosage of propofol. Minor cardiopulmonary adverse events were recorded in the NAPS group compared to OAPS.