Anesthesia or sedation for gastroenterologic endoscopies

Luginbühl, Martin; Vuilleumier, Pascal; Schumacher, Peter; Stüber, Frank (2009). Anesthesia or sedation for gastroenterologic endoscopies. Current opinion in anaesthesiology, 22(4), pp. 524-31. Hagerstown, Md.: Lippincott Williams & Wilkins 10.1097/ACO.0b013e32832dbb7c

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PURPOSE OF REVIEW: Because propofol is the sedative preferred by gastroenterologists, we focus this review on gastroenterologist-directed propofol sedation, provide simulations of the respiratory depressant effect of different dosing protocols and give a perspective on future developments in computer-assisted sedation techniques. RECENT FINDINGS: Propofol use by nonanesthesiologists remains a contraindication in the package insert of propofol in most countries. Sedation guidelines produced by the American Society of Gastroenterology partially contradict those produced by the American Society of Anesthesiologists for sedation by nonanesthesiologists, whereas the German guidelines were developed with anesthesiologists involved. The use of fospropofol, recently approved by the US Food and Drug Administration for sedation, is considered an alternative to propofol by some gastroenterologists. Methodological errors in earlier pharmacological studies have to be solved before widespread use of fospropofol is justified, however. Our simulations show that dosing protocols with small boluses administered at reasonable intervals induce less respiratory depression than large boluses. Interindividual variability of propofol-induced respiratory depression is illustrated by different pharmacokinetic and dynamic parameter sets used in the simulation. Two computer-assisted propofol infusion systems are currently being investigated. They not only incorporate the target effect but also the side effects, which may limit respiratory depression. SUMMARY: Propofol use by gastroenterologists may be well tolerated if appropriate patient selection, staff training, monitoring and low-dose sedation protocols are applied.

Item Type:

Journal Article (Further Contribution)

Division/Institute:

04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic and Policlinic for Anaesthesiology and Pain Therapy

UniBE Contributor:

Luginbühl, Martin; Vuilleumier, Pascal Henri; Schumacher, Peter and Stüber, Frank

ISSN:

0952-7907

Publisher:

Lippincott Williams & Wilkins

Language:

English

Submitter:

Jeannie Wurz

Date Deposited:

04 Oct 2013 15:11

Last Modified:

23 Jan 2018 12:17

Publisher DOI:

10.1097/ACO.0b013e32832dbb7c

PubMed ID:

19512913

Web of Science ID:

000268419800012

URI:

https://boris.unibe.ch/id/eprint/31275 (FactScience: 195713)

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