Dan Med J ϧϫ/Ϫ August ϤϢϣϤ DANISH MEDICAL JOURNAL ϣ ABSTRACT INTRODUCTION: This study provides an evaluation and risk analysis of propofol sedation for endoscopic pulmonary procedures according to our unit’s “gastroenterologic nurse-administered propofol sedation (NAPS) guideline”. MATERIALS AND METHODS: The present study is a prospect- ive descriptive study performed at the Endoscopy Unit, Gentofte Hospital, Copenhagen, from May to July 2009. The study comprised at total of 51 consecutive patients who underwent 77 endoscopic procedures. Only patients above the age of 16 years were eligible for treatment. The exclusion criteria were as follows: American Society of Anesthesiologists (ASA) class > 3, history of sedation-related complications, severe chronic obstructive pulmonary dis- ease. Excluded were patients with a potentially difficult air- way and ventricular retention. Data on the number and type of procedure, baseline characteristics, sedation time, propofol dose administered and adverse events were obtained from medical histories. RESULTS: A total of 23 cases of adverse events were re- corded, including one event of hypotension and 22 events of hypoxaemia. Five patients needed assisted ventilation. The frequency of hypoxaemia in sessions involving bron- choscopy was 17 of 26 (65%) compared with trans-oeso- phageal endoscopic ultrasound (EUS) (17 of 45, 35%) and endoscopic bronchial ultrasound (EBUS) (three of six, 50%). Endoscopist assessment of working conditions was good and patient assessment of discomfort was low. No patients required endotracheal intubation and there was no mor- tality. CONCLUSION: This study supports the conclusion that propofol administered by nurses provides for good working conditions and satisfied patients. But our “NAPS for endo- scopic gastroenterologic procedures” guideline was un- suited for endoscopic pulmonary procedures including EUS. FUNDING: This work was supported by the START research foundation at Gentofte Hospital. TRIAL REGISTRATION: not relevant. Nurse administered propofol sedation (NAPS) without anaesthesiologic assistance has gained increasing popu- larity for gastrointestinal endoscopic procedures, and it was demonstrated that the method is safe provided proper training in airway management is given [1-5]. Propofol administered by anaesthesiologists has been used for sedation during endoscopic pulmonary pro- cedures for some time [6-8], predominantly in cases where midazolam and opiate sedation (conventional regimens) have proven insufficient. Some studies have documented that for flexible bronchoscopy NAPS has the same rate of adverse events as midazolam/opiate sedation [9, 10]. Other studies conclude that propofol has superior characteristics including faster induction (30-60 sec.), faster recovery and return of psychomotor control and equal or superior patient and endoscopist satisfaction [11-13]. At Gentofte Hospital, Copenhagen, Denmark, diagnostic evaluation in patients either diag- nosed with or suspected of lung cancer implies one to three of the following procedures: flexible broncho- scopy, trans-oesophageal endoscopic ultrasound (EUS) or endoscopic bronchial ultrasound (EBUS). The need for repeated procedures, the demand for fast-track evaluations and the high level of discomfort during these procedures have led to an increased demand for sedation [14-16]. The appealing characteristics of propo- fol meet this demand [17]. The feasibility and safety of conscious sedation with propofol for flexible broncho- scopy has been emphasised in some of the above-men- tioned studies, but the data are still limited. The aim of this case series was to report the satisfaction and safety of propofol sedation in a cohort of patients undergoing diagnostic and therapeutic pulmonary endoscopy in a tertiary care hospital, and to investigate whether or not our NAPS guidelines, which are routinely used for gastrointestinal endoscopy, were feasible for pulmonary endoscopy. MATERIAL AND METHODS The pilot was terminated after 51 patients due to an unacceptably high rate of hypoxia as evaluated by the team together. All of the 51 consecutive patients in the pilot were included in this case series. Propofol was administered by experienced “NAPS” nurses in an anaesthesiology set-up where the anaes- thesiology personnel served as observers with respons- ibility for the sedation. The dosing regimen was given according to the already implemented “NAPS for endo- scopic gastroenterologic procedures guidelines”. The se- lection of patients for NAPS in the pilot was based on the following: Inclusion criteria: age ≥ 16 years; exclu- Nurse administered propofol sedation for pulmonary endoscopies requires a specific protocol Jeppe Thue Jensen 1, 4 , Anne-Marie Banning 2 , Paul Clementsen 3 , Anne Hammering 1 , Pernille Hornslet 4 , Tina Horsted 1 & Peter Vilmann 5 ORIGINAL ARTICLE 1) Department of Anaesthesiology, Gentofte Hospital 2) Acute Admission, Køge Hospital 3) Department of Pulmonary Medicine, Gentofte Hospital 4) Department of Same Day Surgery, Endoscopic Unit, Gentofte Hospital 5) Department of Surgery, Herlev Hospital Dan Med J 2012;59(8):A4467