Propofol use in endoscopic retrograde cholangiopancreatography and endoscopic ultrasound

Table 1 Characteristics of commonly used pharmacological agents used during endoscopy

Agent	Onset of action (min)	Duration of action	Half life	Metabolism
Midazolam	1.0-2.5	2-6 h	1.8-6.4 h	Hepatic and intestinal
Fentanyl	< 1.5	1-2 h	2-7 h	Hepatic
Meperidine	5	2-4 h	2-7 h	Hepatic
Propofol	> 1	3-10 min	Triphasic: 2.2 min, 20 min, 8 h	Hepatic

Modified from Triantafillidis et al[30].

Table 2 American Society of Gastrointestinal Endoscopy training guidelines for nonanesthesiologist-administered propofol for gastrointestinal endoscopy

Didactic training

Pharmacological overview of propofol

Review of continuum of sedation

Patient assessment specific to propofol

Examination

Airway workshop

Training to recognize and manage respiratory complications

Airway assessment

Restore airway patency with manual, oral or nasopharyngeal techniques

Bag-mask ventilation

Basic and advanced cardiac life support

Review of physiologic monitoring techniques (capnography)

Simulation training

Clinical simulators with trained instructors

Preceptorship

Adopt and institute a propofol sedation program within endoscopy unit

Formulate set of policies and procedures pertaining to NAAP

Train all relevant members of staff

Institutional approval

Performance measures designed to assess patient safety and satisfaction

Adapted from Vargo et al[28]. NAAP: Nonanesthesiologist-administered propofol.