Background & Aims: Endoscopist-directed propofol sedation (EDP) remains controversial. We sought to update the safety experience of EDP and estimate the cost of using anesthesia specialists for endoscopic sedation.
Methods: We reviewed all published work using EDP. We contacted all endoscopists performing EDP for endoscopy that we were aware of to obtain their safety experience. These complications were available in all patients: endotracheal intubations, permanent neurologic injuries, and death.
Results: A total of 646,080 (223,656 published and 422,424 unpublished) EDP cases were identified. Endotracheal intubations, permanent neurologic injuries, and deaths were 11, 0, and 4, respectively. Deaths occurred in 2 patients with pancreatic cancer, a severely handicapped patient with mental retardation, and a patient with severe cardiomyopathy. The overall number of cases requiring mask ventilation was 489 (0.1%) of 569,220 cases with data available. For sites specifying mask ventilation risk by procedure type, 185 (0.1%) of 185,245 patients and 20 (0.01%) of 142,863 patients required mask ventilation during their esophagogastroduodenoscopy or colonoscopy, respectively (P < .001). The estimated cost per life-year saved to substitute anesthesia specialists in these cases, assuming they would have prevented all deaths, was $5.3 million.
Conclusions: EDP thus far has a lower mortality rate than that in published data on endoscopist-delivered benzodiazepines and opioids and a comparable rate to that in published data on general anesthesia by anesthesiologists. In the cases described here, use of anesthesia specialists to deliver propofol would have had high costs relative to any potential benefit.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1053/j.gastro.2009.06.042 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Worldwide Chronic Retrieval Experience of Helix-Fixation Leadless Cardiac Pacemakers.
J Am Coll Cardiol
December 2024
Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Background: The growing use of leadless pacemaker (LP) technology requires safe and effective solutions for retrieving and removing these devices over the long term.
Objectives: This study sought to evaluate retrieval and removal of an active helix-fixation LP studied in worldwide regulatory clinical trials.
Methods: Subjects enrolled in the LEADLESS II phase 1 investigational device exemption, LEADLESS Observational, or LEADLESS Japan trials with an attempted LP retrieval at least 6 weeks postimplantation were included.
Impact of Perceived Discrimination and Pandemic Attitudes on Cancer Screening Behaviors Among Asian American Women: A Sequential Explanatory Mixed-Methods Study.
J Am Coll Radiol
December 2024
Vice Chair for Radiology, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts; Co-Chair, RSNA Health Equity Committee; Associate Editor, Journal of the American College of Radiology.
Purpose: The aim of this study was to assess how pandemic-related health concerns and discrimination affected cancer screenings among Asian American women (AAW).
Methods: A two-phase explanatory mixed-methods study was conducted. In phase 1, a survey was distributed among AAW eligible for lung, breast, or colorectal cancer screening to assess delays during the pandemic, concerns about contracting coronavirus disease 2019 (COVID-19), barriers to care, and experiences of discrimination.
A Qualitative Analysis of Rural Community Vaccination Barriers During the COVID-19 Pandemic.
Vaccines (Basel)
December 2024
College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, WA 99202, USA.
Background/objectives: Rural communities in the United States experience increased disparity of care for both general healthcare services and access to routine vaccines. Previous research has indicated a 40% lower vaccination rate in rural communities, as compared to urban counterparts. Having a better understanding regarding factors influencing lower vaccination rates in rural areas could help public health officials prepare for future vaccination efforts.
View Article and Find Full Text PDFOn Security Performance of SWIPT Multi-User Jamming Based on Mixed RF/FSO Systems with Untrusted Relay.
Sensors (Basel)
December 2024
Key Laboratory of Electromagnetic Wave Information Technology and Metrology of Zhejiang Province, College of Information Engineering, China Jiliang University, Hangzhou 310018, China.
This paper presents research on the security performance of a multi-user interference-based mixed RF/FSO system based on SWIPT untrusted relay. In this work, the RF and FSO channels experience Nakagami-m fading distribution and Málaga (M) turbulence, respectively. Multiple users transmit messages to the destination with the help of multiple cooperating relays, one of which may become an untrusted relay as an insider attacker.
View Article and Find Full Text PDFSafety After Dark: A Privacy Compliant and Real-Time Edge Computing Intelligent Video Analytics for Safer Public Transportation.
Sensors (Basel)
December 2024
Australian Urban Research Infrastructure Network (AURIN), University of Melbourne, Melbourne, VIC 3052, Australia.
Public transportation systems play a vital role in modern cities, but they face growing security challenges, particularly related to incidents of violence. Detecting and responding to violence in real time is crucial for ensuring passenger safety and the smooth operation of these transport networks. To address this issue, we propose an advanced artificial intelligence (AI) solution for identifying unsafe behaviours in public transport.
View Article and Find Full Text PDFWant AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!