Nurse-administered propofol sedation compared with midazolam and meperidine for EUS: a prospective, randomized trial.

Author(s): Dewitt J, McGreevy K, Sherman S, Imperiale TF

Affiliation(s): Departments of Gastroenterology and Hepatology, Indiana University Medical Center and Regenstrief Institute, Inc, Indianapolis, Indiana, USA.

Publication date & source: 2008-09, Gastrointest Endosc., 68(3):499-509. Epub 2008 Jun 17.

Publication type: Research Support, Non-U.S. Gov't

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.