Propofol administration by anesthesiologists versus endoscopists during colonoscopy: Does it make a difference?

Abstract

Background: Propofol anesthesia for endoscopic procedures has gained wide acceptance among physicians and patients. Much debate remains though whether propofol can be safely administered by non-anesthesiologists. Objective: To compare the procedural outcome of patients undergoing colonoscopy with Propofol target-controlled infusion administered by anesthesiologists vs. non-anesthesiologists. Design: A retrospective review. Setting: A private community hospital in Dubai, United Arab Emirates. Patients and Methods: All consecutive patients (age > 13 years, with American Society of Anesthesiologists class I-II and no other contraindications to administration of sedation by non-anesthesiologists) who underwent colonoscopy between January 1, 2017 and September 30, 2017. In the initial part of the study, propofol was administered by an anesthesiologist until the endoscopists were trained to provide propofol anesthesia via targeted-controlled infusion [TCI] by syringe pump. Intraprocedural data was collected in a prospective registry. Statistical analysis was performed using Chi square and student t test. Main Outcome Measures: Cecal intubation rate, procedural time, procedural-related complications, and polypectomy/biopsy rate. Sample Size: 347 patients. Results: Group 1 [anesthesiologists] 84 patients, Group 2 [endoscopists] 263 patients. Mean age was 44.8 and 46.9 years in Group 1 and 2, respectively (P = 0.17). There was no difference in gender distribution. The mean procedural time was 21 minutes in both groups (P = 0.93). The cecal intubation rate was similar [92.9% in Group 1 vs. 94.3% in Group 2, P = 0.40). No difference in procedural-related complications was noted between groups, with 1 patient in Group 2 sustaining endoscopic perforation during balloon dilation of a near obstructing anastomotic stricture. Except for the patient with endoscopic perforation, no patient required advanced airway management. Conclusions: Propofol can be safely administered by endoscopists using target-controlled infusion. Similar total procedural time and cecal intubation rate can be achieved without increased risk of procedural-related complications. Limitations: Retrospective review, community-based hospital, elective cases, small cohort size. Conflict of Interest: None.