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

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.

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Early Oral Switch to Linezolid for Low-risk Patients With Staphylococcus aureus Bloodstream Infections: A Propensity-matched Cohort Study

Clinical Infectious Diseases ◽

10.1093/cid/ciy916 ◽

2018 ◽

Vol 69 (3) ◽

pp. 381-387 ◽

Cited By ~ 15

Author(s):

Rein Willekens ◽

Mireia Puig-Asensio ◽

Isabel Ruiz-Camps ◽

Maria N Larrosa ◽

Juan J González-López ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Cohort Study ◽

Propensity Score ◽

Hospital Stay ◽

Propensity Score Matching ◽

Length Of Hospital Stay ◽

Low Risk ◽

Significant Difference ◽

Risk Patients ◽

Oral Switch

Abstract Background Oral switch to linezolid is a promising alternative to standard parenteral therapy (SPT) in Staphylococcus aureus bacteremia (SAB). Methods We conducted a prospective cohort study of all adult cases of SAB between 2013 and 2017 in a Spanish university hospital. We compared the efﬁcacy, safety, and length of hospital stay of patients receiving SPT and those where SPT was switched to oral linezolid between days 3 and 9 of treatment until completion. We excluded complicated SAB and osteoarticular infections. A k-nearest neighbor algorithm was used for propensity score matching with a 2:1 ratio. Results After propensity score matching, we included 45 patients from the linezolid group and 90 patients from the SPT group. Leading SAB sources were catheter related (49.6%), unknown origin (20.0%), and skin and soft tissue (17.0%). We observed no difference in 90-day relapse between the linezolid group and the SPT group (2.2% vs 4.4% respectively; P = .87). No statistically significant difference was observed in 30-day all-cause mortality between the linezolid group and the SPT group (2.2% vs 13.3%; P = .08). The median length of hospital stay after onset was 8 days in the linezolid group and 19 days in the SPT group (P < .01). No drug-related events leading to discontinuation were noted in the linezolid group. Conclusions Treatment of SAB in selected low-risk patients with an oral switch to linezolid between days 3 and 9 of treatment until completion yielded similar clinical outcomes as SPT, allowing earlier discharge from the hospital.

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Assessing the safety of physician-directed nurse-administered propofol sedation in low-risk patients undergoing endoscopy and colonoscopy

Endoscopy International Open ◽

10.1055/s-0042-121667 ◽

2017 ◽

Vol 05 (02) ◽

pp. E110-E115 ◽

Cited By ~ 12

Author(s):

Dharshan Sathananthan ◽

Edward Young ◽

Garry Nind ◽

Biju George ◽

Angelie Ashby ◽

...

Keyword(s):

Adverse Events ◽

Selection Criteria ◽

Low Risk ◽

Propofol Sedation ◽

Tertiary Teaching ◽

Risk Patients ◽

Tertiary Teaching Hospital ◽

Patient Selection Criteria ◽

Balanced Propofol Sedation ◽

A Prospective Study

Abstract Background and study aims Physician-directed nurse-administered balanced propofol sedation (PhD NAPS) in patients undergoing endoscopy and/or colonoscopy is being increasingly utilized worldwide. However, this method of sedation is not universally employed in Australian hospitals due to concerns surrounding its safety. The aim of this study was to assess the safety of PhD NAPS in low-risk patients undergoing endoscopy and/or colonoscopy. Patients and methods This study was conducted at a single tertiary teaching hospital in Adelaide, Australia. It was a prospective study involving 1000 patients with an ASA score of 1 – 3 presenting with any indication for endoscopy, colonoscopy or both. A total of 981 patients (451 male) with a mean age of 53 years (range: 16 – 87) were recruited from January 2010 to October 2012. 440 endoscopies, 420 colonoscopies, and 121 combined procedures were performed. The intra-procedural adverse events (AEs) were recorded. Results There were no major intra-procedural adverse events. Minor AEs occurred in 6.42 % of patients, and resolved spontaneously or with intravenous fluid boluses in all cases. Conclusion PhD NAPS is safe when the proceduralist and nursing staff are adequately trained and strict patient selection criteria are used.

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636 SHORT-TERM OUTCOME FOR HIGH-RISK PATIENTS AFTER ESOPHAGECTOMY

Diseases of the Esophagus ◽

10.1093/dote/doab052.636 ◽

2021 ◽

Vol 34 (Supplement_1) ◽

Author(s):

Victor Plat ◽

Wessel Stam ◽

Boukje Bootsma ◽

Jennifer Straatman ◽

Thomas Klausch ◽

...

Keyword(s):

High Risk ◽

Propensity Score ◽

Propensity Score Matching ◽

Charlson Comorbidity Index ◽

Short Term ◽

Term Outcome ◽

High Risk Patients ◽

Short Term Outcome ◽

Risk Patients ◽

Comorbidity Index

Abstract Transthoracic esophagectomy (TTE) for esophageal cancer facilitates mediastinal dissection, however it has a significant impact on cardiopulmonary status. High-risk patients may therefore be better candidates for transhiatal esophagectomy (THE) in order to prevent serious complications. This study addressed short-term outcome following TTE and THE in patients that are considered to have a higher risk of surgery-related morbidity. Methods This population-based study included patients who underwent a curative esophagectomy between 2011 and 2018, registered in the Dutch Upper GI Cancer Audit. The Charlson comorbidity index was used to assign patients to a low-risk (score ≤ 1) and high-risk group (score ≥ 2). Propensity score matching was applied to produce comparable groups between high-risk patients receiving TTE and THE. Primary endpoint was mortality (in-hospital/30-day mortality), secondary endpoints included morbidity and oncological outcomes. Additionally, a matched subgroup analysis was performed, including only cervical reconstructions. Results Of 5438 patients, 945 and 431 high-risk patients underwent TTE and THE respectively. After propensity score matching, mortality (6.3% vs 3.3%, P = 0.050), overall morbidity, Clavien-Dindo ≥3 complications, pulmonary complications, cardiac complications and re-interventions were significantly more observed after TTE compared to THE. A significantly higher mortality after TTE with a cervical reconstruction was found compared to THE (7.0% vs 2.2%, P = 0.020). Conclusion Patients with a high Charlson comorbidity index predispose for a complicated postoperative course after esophagectomy, this was more outspoken after TTE compared to THE. In daily practice these outcomes should be balanced with the lower lymph node yield, but comparable positive node count and radicality after THE.

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Cecal intubation time between cap-assisted water exchange and water exchange colonoscopy

European Journal of Gastroenterology & Hepatology ◽

10.1097/meg.0000000000000954 ◽

2017 ◽

Vol 29 (11) ◽

pp. 1296-1302 ◽

Cited By ~ 4

Author(s):

Chih-Wei Tseng ◽

Malcolm Koo ◽

Yu-Hsi Hsieh

Keyword(s):

Water Exchange ◽

Intubation Time ◽

Cecal Intubation ◽

Cecal Intubation Time

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Risk factors associated with longer cecal intubation time: a systematic review and meta-analysis

International Journal of Colorectal Disease ◽

10.1007/s00384-018-3014-x ◽

2018 ◽

Vol 33 (4) ◽

pp. 359-365 ◽

Cited By ~ 2

Author(s):

Veeravich Jaruvongvanich ◽

Tomoki Sempokuya ◽

Passisd Laoveeravat ◽

Patompong Ungprasert

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Meta Analysis ◽

Intubation Time ◽

Cecal Intubation ◽

Factors Associated ◽

Cecal Intubation Time

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Colorectal endoscopic mucosal resection with submucosal injection of epinephrine versus hypertonic saline in patients taking antithrombotic agents: propensity-score-matching analysis

BMC Gastroenterology ◽

10.1186/s12876-019-1114-x ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 2

Author(s):

Daisuke Yamaguchi ◽

Hisako Yoshida ◽

Kei Ikeda ◽

Yuki Takeuchi ◽

Shota Yamashita ◽

...

Keyword(s):

Propensity Score ◽

Adverse Events ◽

Propensity Score Matching ◽

Endoscopic Mucosal Resection ◽

Hypertonic Saline ◽

Colon Polyps ◽

Antithrombotic Agents ◽

Submucosal Injection ◽

Mucosal Resection ◽

Increased Risk

Abstract Background Endoscopic mucosal resection (EMR) to remove colon polyps is increasingly common in patients taking antithrombotic agents. The safety of EMR with submucosal saline injection has not been clearly demonstrated in this population. Aims The present study aimed to evaluate the efficacy and safety of submucosal injection of saline–epinephrine versus hypertonic saline in colorectal EMR of patients taking antithrombotic agents. Methods This study enrolled 204 patients taking antithrombotic agents among 995 consecutive patients who underwent colonic EMR from April 2012 to March 2018 at Ureshino Medical Center. Patients were divided into two groups according to the injected solution: saline–epinephrine or hypertonic (10%) saline (n = 102 in each group). Treatment outcomes and adverse events were evaluated in each group and risk factors for immediate and post-EMR bleeding were investigated. Results There were no differences between groups in patient or polyp characteristics. The main antithrombotic agents were low-dose aspirin, warfarin, and clopidogrel. Propensity-score matching created 80 matched pairs. Adjusted comparisons between groups showed similar en bloc resection rates (95.1% with saline–epinephrine vs. 98.0% with hypertonic saline). There were no significant differences in adverse events (immediate EMR bleeding, post-EMR bleeding, perforation, or mortality) between groups. Multivariate analyses revealed that polyp size over 10 mm was associated with an increased risk of immediate EMR bleeding (odds ratio 12.1, 95% confidence interval 2.0–74.0; P = 0.001). Conclusions Two tested solutions in colorectal EMR were considered to be both safe and effective in patients taking antithrombotic agents.

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