背景:遵循皇家麻醉师学院和英国胃肠病学会的建议,我们报告了由一名顾问麻醉师在5年的时间内对复杂的内镜手术进行异丙酚镇静的结果.
方法:在内窥镜检查部门为复杂或以前无法成功完成的程序提供每周一次的会议。深度镇静是通过间歇性丙泊酚推注剂量提供的,必要时补充芬太尼,滴定到临床效果。患者通常处于半俯卧位或侧卧位,并自发呼吸补充鼻氧气的空气。服务评估包括患者召回,内窥镜医师对条件的满意度,手术成功和气道相关不良结局。
结果:我们完成了1000个程序,其中42.5%为内镜逆行胰胆管造影术,其余包括3-156分钟的不同范围的内窥镜手术。79%的病例程序条件优良,完成了以前被放弃的261个程序,246名患者(24.6%)的经历比以前更好,没有人回忆起他们手术的任何部分。三名患者需要短暂的袋和面罩通气,12例患者使用了鼻气道,但都不需要气管插管或血管加压药支持.
结论:这些指南促进了异丙酚镇静服务,对患者和内窥镜医师有相当大的益处。麻醉师提供异丙酚深度镇静,在气道不安全的患者中,看起来实用,有效和高效。对气道的小调整相当普遍,但不良事件的发生率和对气道仪器的需求较低.
BACKGROUND: Following recommendations from the Royal College of Anaesthetists and the British Society of Gastroenterology, we report our results of propofol sedation for complex endoscopic procedures delivered by a single consultant anaesthetist over a 5-year period.
METHODS: A weekly session was provided in the endoscopy department for procedures that were complex or could previously not be completed successfully. Deep sedation was provided by intermittent propofol bolus doses, supplemented with fentanyl where necessary, titrated to clinical effect. Patients were usually in semiprone or lateral positions and spontaneously breathed air supplemented with nasal oxygen. Service evaluation included patient recall, endoscopist satisfaction with conditions, procedural success and airway-related adverse outcomes.
RESULTS: We completed 1000 procedures, 42.5% of which were endoscopic retrograde cholangiopancreatography, with the remainder comprising a diverse range of endoscopic procedures of 3-156 min duration. Procedural conditions were excellent in 79% of cases, 261 procedures were completed which had been previously abandoned, 246 patients (24.6%) had a better experience than previously and none recalled any part of their procedure. Three patients required transient bag and mask ventilation, and nasal airways were used in 12 patients, but none required tracheal intubation or vasopressor support.
CONCLUSIONS: These
guidelines facilitated a propofol sedation service with considerable benefits for patients and endoscopists. Provision of deep propofol sedation by an anaesthetist, in patients with an unsecured airway, appears practical, effective and efficient. Small adjustments to the airway were fairly common, but the incidence of adverse events and requirement for airway instrumentation was low.