Safety and tolerability outcomes of nonanesthesiologist-administered propofol using target-controlled infusion in routine GI endoscopy

Background and aims Non-Anesthesiologist-Administered Propofol (NAAP) is increasingly accepted, but there is limited data on drug administration via Target Controlled Infusion (TCI) in clinical practice. TCI adjusts drug infusion based on patient-specific parameters, maintaining a constant drug dose to reduce the risk of adverse events due to drug overdosing and enhance patient comfort. The aims of this study are to assess the rate of adverse events (AEs) and evaluate patient satisfaction with NAAP via TCI in a retrospective cohort of 18,302 procedures. Methods Sequential enrolment of low-risk patients (ASA score 1 and 2) undergoing outpatient gastrointestinal (GI) endoscopic procedures, including esophagogastroduodenoscopies (EGDs) and colonoscopies, at IRCCS San Raffaele Hospital (Milan, Italy) between May 2019 and November 2021. Results Data from 7,162 EGDs and 11,140 colonoscopies were analyzed. The median age was 59.1±14.8 years, median BMI 24.9 (3.7). Male-to-female ratio was equal to 8,798 (48.1%)/9,486 (51.9%). AEs occurred in 240 procedures (1.3%) out of the total cohort, with no differences between EGDs and colonoscopies (N=100, 1.4% and N=140, 1.2%, respectively, p=0.418). A total of 15,875 patients (98.9%) indicated they would likely repeat the procedure with the same sedation protocol. Age (OR 1.02 95% CI 1.01-1.03, p<0.008) was the only independent factor associated with overall AEs. Conclusions NAAP via TCI is an effective and safe sedation method for routine endoscopy. Proper propofol dosage based on individual patients and the presence of trained operators are crucial for NAAP sedation management.