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Revista Española de Enfermedades Digestivas
Print version ISSN 1130-0108
Rev. esp. enferm. dig. vol.110 n.4 Madrid Apr. 2018
https://dx.doi.org/10.17235/reed.2018.5531/2018
LETTERS TO THE EDITOR
Safety of propofol sedation directed by endoscopists: how long should we continue to generate evidence?
1Servicio de Medicina de Aparato Digestivo. Unidad de Endoscopias. Consulta de Alto Riesgo de Neoplasias Gastrointestinales. Hospital Universitario 12 de Octubre. Madrid, España
2Servicio de Medicina de Aparato Digestivo. Unidad de Enfermedad Inflamatoria Intestinal. Hospital Universitario 12 de Octubre. Madrid, España
Key words: Propofol; Sedation; Endoscopy; Patient safety; Adverse drug events
Dear Editor,
Maestro Antolín et al. 1 presented a series of more than 33,000 sedations performed with propofol by endoscopists and observed a frequency of cardiorespiratory adverse events of 0.13%. In Spain, the first studies demonstrating the excellent safety of propofol sedation led by endoscopists were published more than ten years ago 2. Nonetheless, the administration of propofol by endoscopists is a source of permanent friction with the societies of anesthesiology, which is based more on a clear conflict of economic interest on the behalf of the anesthesiologists than supported by scientific evidence.
In a multi-center study conducted in Germany with more than 24,000 patients sedated by endoscopists, the incidence of serious adverse events was only 0.016% 3. Clearly, this minimal risk related to sedation in endoscopy makes it difficult to design prospective, comparative (endoscopist versus anesthesiologist), randomized studies with the necessary statistical power to examine these relationships. It has been demonstrated that the administration of propofol by the endoscopist is cost-effective. In order to attain a similar cost-effectiveness with anesthesiologist-assisted procedures, the mortality rate following sedation by endoscopists would need to increase by 31-fold or the costs of anesthesia reduced 17-fold 4.
In view of this plethora of data, it is difficult to justify the presence of an anesthesiologist for short procedures, of low complexity, or for patients with low or moderate anesthetic risk. In the latter case, the proper training of endoscopists to provide safe sedation has been sufficiently demonstrated, supported by the scientific societies 5, and there is no turning back.
Therefore, rather than a confrontation between different specialties where the corporatism of the anesthesiology societies and their interest in monopolizing the use of a safe drug such as propofol prevails, even without scientific support, anesthesiologists, endoscopists and nurses should instead work together for the benefit of our patients.
Bibliografía
1. Maestro Antolín S, Moreira Da Silva B, Santos Santamarta F, et al. Complicaciones cardio-respiratorias graves derivadas de la sedación con propofol controlado por endoscopista en nuestra unidad en los últimos 6 años (2011-2016) (Ref: 5282/2017). Rev Esp Enferm Dig 2018;110(4):237-9. DOI: 10.17235/reed.2018.5282/2017 [ Links ]
2. Sáenz-López S, Rodríguez Muñoz S, Rodríguez-Alcalde D, et al. Endoscopist controlled administration of propofol: an effective and safe method of sedation in endoscopic procedures. Rev Esp Enferm Dig 2006;98(1):25-35. DOI: 10.4321/S1130-01082006000100004 [ Links ]
3. Sieg A, Beck S, Scholl SG, et al. Safety analysis of endoscopist-directed propofol sedation: a prospective, national multicenter study of 24,441 patients in German outpatient practices. J Gastroenterol Hepatol 2014; 29(3):517-23. DOI: 10.1111/jgh.12458 [ Links ]
4. Hassan C, Rex DK, Cooper GS, et al. Endoscopist-directed propofol administration versus anesthesiologist assistance for colorectal cancer screening: a cost-effectiveness analysis. Endoscopy 2012;44(5):456-64. DOI: 10.1055/s-0032-1308936 [ Links ]
5. Dumonceau JM, Riphaus A, Beilenhoff U, et al. European curriculum for sedation training in gastrointestinal endoscopy: position statement of the European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastroenterology and Endoscopy Nurses and Associates (ESGENA). Endoscopy 2013;45(6):496-504. DOI: 10.1055/s-0033-1344142 [ Links ]