Nurse-administered propofol sedation compared with midazolam and meperidine for EUS: a prospective, randomized trial

BackgroundThe utility of nurse-administered propofol sedation (NAPS) compared with midazolam and meperidine (M/M) for EUS is not known.ObjectiveTo compare recovery times, costs, safety, health personnel, and patient satisfaction of NAPS and M/M for EUS.DesignProspective, randomized, single-blinded trial.SettingTertiary-referral hospital in Indianapolis, Indiana.PatientsOutpatients referred for EUS.InterventionsSedation with M/M or NAPS. The patient and recovery nurse were blinded; however, the sedating nurse, endoscopist, and recording research nurse were unblinded to the sedatives used. A capnography, in addition to standard monitoring, was used. A questionnaire and visual analog scale assessed patient, endoscopist, and sedating nurse satisfaction.Main Outcome MeasurementsRecovery times, costs, safety, health personnel, and patient satisfaction in both groups.ResultsEighty consecutive patients were randomized to NAPS (n = 40) or M/M (n = 40). More patients in the propofol group were current tobacco users; patient demographics, procedures performed, mean procedure length, and the overall frequency of adverse events were otherwise similar. Compared with M/M, NAPS was associated with a faster induction of sedation (2.3 vs 5.7 minutes, respectively; P = .001) and full recovery time (29 vs 49 minutes, respectively; P = .001), higher postprocedure patient satisfaction, and quicker anticipated return to baseline function. At discharge, total costs (recovery plus medications) were similar between the propofol ($406) and M/M groups ($399; P = .79).LimitationLow-risk patient population.ConclusionsCompared with M/M, NAPS for an EUS offered a faster sedation induction and full recovery time, higher postprocedure patient satisfaction, and a quicker anticipated return to baseline function. Total costs were similar between the groups.