Nurse-administered propofol sedation compared with midazolam and meperidine for EUS: a prospective, randomized trial - 23/08/11

Doi : 10.1016/j.gie.2008.02.092

John DeWitt, MD ^⁎, Kathleen McGreevy, MD, Stuart Sherman, MD, Thomas F. Imperiale, MD
Current affiliations: Departments of Gastroenterology and Hepatology, Indiana University Medical Center and Regenstrief Institute, Inc, Indianapolis, Indiana, USA

Reprint requests: John DeWitt, MD, Division of Gastroenterology and Hepatology, Indiana University Medical Ctr, 550 N. University Blvd, UH 4100, Indianapolis, IN 46202.

Indianapolis, Indiana, USA

Abstract

Background

The utility of nurse-administered propofol sedation (NAPS) compared with midazolam and meperidine (M/M) for EUS is not known.

Objective

To compare recovery times, costs, safety, health personnel, and patient satisfaction of NAPS and M/M for EUS.

Design

Prospective, randomized, single-blinded trial.

Setting

Tertiary-referral hospital in Indianapolis, Indiana.

Patients

Outpatients referred for EUS.

Interventions

Sedation with M/M or NAPS. The patient and recovery nurse were blinded; however, the sedating nurse, endoscopist, and recording research nurse were unblinded to the sedatives used. A capnography, in addition to standard monitoring, was used. A questionnaire and visual analog scale assessed patient, endoscopist, and sedating nurse satisfaction.

Main Outcome Measurements

Recovery times, costs, safety, health personnel, and patient satisfaction in both groups.

Results

Eighty consecutive patients were randomized to NAPS (n = 40) or M/M (n = 40). More patients in the propofol group were current tobacco users; patient demographics, procedures performed, mean procedure length, and the overall frequency of adverse events were otherwise similar. Compared with M/M, NAPS was associated with a faster induction of sedation (2.3 vs 5.7 minutes, respectively; P = .001) and full recovery time (29 vs 49 minutes, respectively; P = .001), higher postprocedure patient satisfaction, and quicker anticipated return to baseline function. At discharge, total costs (recovery plus medications) were similar between the propofol ($406) and M/M groups ($399; P = .79).

Limitation

Low-risk patient population.

Conclusions

Compared with M/M, NAPS for an EUS offered a faster sedation induction and full recovery time, higher postprocedure patient satisfaction, and a quicker anticipated return to baseline function. Total costs were similar between the groups.

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Abbreviations : ACLS, ASA, EUS-FNA, EECO₂, EKG, IVP, M/M, MOAA/S, NAPS, PPV, RN, SBP, SpO₂, VAS