Tu1500 Safety of Nurse-Administered Propofol Sedation During Gastric Endoscopic Submucosal Dissection

Tu1500 Safety of Nurse-Administered Propofol Sedation During Gastric Endoscopic Submucosal Dissection Shinsuke Kiriyama, Hiroshi Naito, Minoru Fukuchi, Kazuhisa Yuasa, Katsuhiko Horiuchi Department of Surgery, Gunma Central General Hospital, Maebashi, Gunma, Japan; Department of Gastroenterology, Gunma Central General Hospital, Maebashi, Gunma, Japan; Department of General Surgical Science, Graduate School of Medicine, Gunma University, Maebashi, Gunama, Japan Background: Endoscopic submucosal dissection (ESD) for early gastric cancer is a relatively long procedure performed under moderate and deep sedation that requires safe management. Currently propofol is under evaluation as an alternative to the midazolam for sedation during endoscopic procedures. The purpose of this study was to evaluate the nurse-administered propofol sedation (NAPS) during gastric ESD. Methods: Eighteen patients with early gastric cancer scheduled for ESDs from March to November 2010 included in this prospective study. All ESDs were performed by one endoscopist and two nurses who were trained through a series of lectures about propofol. One nurse supported only ESD procedure, and another nurse managed only propofol sedation. Infusion pump for exclusive use of propofol (Terumo Corporation, Tokyo, Japan), ITKnife 2 (Olympus medical systems) and hyaluronic acid (Johnson & Johnson, Tokyo, Japan) and were used for all procedures. In accordance with the common scale between doctor and nurse, all patients received 0.5mg/kg induction dose and 3mg/kg/h maintenance dose of propofol using infusion pump. Depending when patients responded to calling their names, adjustments made in 1mg/kg/h increments. If systolic blood pressure dropped below 80mmHg or saturation down below 90%, maintenance dose reduced 1mg/kg/h. All patients received 15mg pentazocine at start and 60 minutes into ESDs. All maintenance rates were changed after confirmation to the operator doctor. Results: Mean age was 71 years old (range; 59-83), mean tumor size was 22mm (10-45), mean resection size was 43mm (20-60) and mean procedure time was 53 minutes (15-120). Mean total amount of propofol infusion dose was 240mg (110610). There were no cases of desaturation below 90% or hypotension below 80mmHg. All patients were possible to hear the account of their ESD treatment at 15 minutes after finish time of the procedure. In the ward after procedure, there were no patients with desaturation and unsteady gait due to prolonged sedation. Conclusion: Gasrtic ESD patients receiving NAPS recovered as safe. This method has possibility of the operator endoscopist’s concentration to the ESD procedure, to reduce burdens of sedation management. It is necessary to discuss about education and license for nurse. Multi-center investigations of propofol management should be conducted by gastroenterologists in various countries.