Implementation and spreading of propofol sedation by endoscopist in Spain: a successful story.
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1 Implementation and spreading of propofol sedation by endoscopist in Spain: a successful story. Leopoldo López Rosés MD Hospital Lucus Augusti. Lugo. Spain.
2 Possible conflicts of interest No conflicts L. López Rosés
3 Colonoscopy in Spain, by 1990: No sedation But things have changed More complex procedures Longer procedures Patients preferences Sedation, necessary L. López Rosés
4 Spain 1990 s Begins sedation, but A Hospital.. No sedation B Hospital.. Sedation by anaesthesiologists C Hospital Sedation by endoscopists L. López Rosés
5 2003. Nationwide survey. 175 / 233 Units. Aparicio J. H. V. Candelaria. Gran Canaria Sedation in colonoscopies.. 48 % Drugs: Midazolam + opioids. 60% Propofol. 15 % Others.. 25 % Anaesthesiologist: No. 23% < 50%... 53% > 50%... 24% Pulsioximeter No.. 6% < 50%... 17% > 50%... 77% L. López Rosés
6 2004. Cataluña Survey. Campo R. Gastroenterol Hepatol 2004; 27(3): 205 Colonoscopies under sedation.. 61% Anaesthesiologist 25% Galicia Survey. Cubiella J. Rev Esp Enf Dig 2005; 97(1): Colonoscopies under sedation.. 55% Anaesthesiologist 0 45% Pulsioximeter. 60 % Recovery room.. 45% L.López Rosés
7 Madrid. June SEPD Anual Meeting. Consensus conference. Sedation in Digestive Endoscopy: By whom, to whom, where and how? Name of presenter
8 Spanish law permits the full practice of Medicine to any MD. No bundaries between specialties. There is no intrusiveness. It is necessary to possess de knowledge, mastery of technique and to employ the appropriate technical means. Competence must be achieved during posgraduate training and / or trough specific courses. Trained staff, monitoring enough, cpr equipment available. Sedation informed consent. L.L.Rosés
9 SEED Guide lines 2006 Endoscopy 2014;46: L.L.Rosés
10 SEED courses of sedation with Propofol. Aim: to provide endoscopists of the theoretical and practical basis for effective and safe sedation with propofol. Composition: 3 days course. a) Lectures: Pharmacology of Propofol Scientific evidence. Guide lines. Curriculum for sedation. Experience in a university hospital. Infusion pumps workshop. b) Cardiopulmonary resuscitation course. c) Practices of sedation with propofol in an endoscopy unit. L.López Rosés
11 L.López Rosés
12 Results: Initially, developed in 4 hospitals ( Palencia, Gerona, Alicante, Lugo). Actually, in 16. Nº of courses 44 Attendees (until oct 2016) L.López Rosés
13 Courses of sedation SEED. Distribution of attendees, by years Total ( doctors / 177 nurses ) Name of presenter
14 Courses of sedation. Attendees survey ( 2014 ). Before course: Propofol. 31% Traditional.. 62% No sedation 7% After course: Endoscopist 55.2% Propofol % 2º staff % Anaesthesiologist % L.L.Rosés
15 Gastrointestinal Endoscopy Sedation and monitoring practices in Spain: A nationwide Survey in the year Lucendo AJ. Endoscopy 2015, 47: questionnaries 23% responders. Sedation in colonoscopy > 95% 76.1 % ( 80 % propofol ) Pre colonoscopy risk assessment % Monitoring % Recovery room 94.8 % Records of sedation % Anaesthesiologist % 2º MD 25.7 % Gastroenterologist % Staff Nurse % Resident 10.4 % Nurse auxiliar % Other... 9 % L.López Rosés
16 L.López Rosés
17 L.López Rosés
18 Gastroenterologists beliefs regarding changes to enhance sedation 1.- Training auxiliary staff in sedation and cpr % 2.- Gastroenterologists training.. 25 % 3.- Wider availability of monitoring and recovery resources % 4.- Improving availability of anaesthesiologist 24.3 % 5.- New regulations / laws % 6.- Support training courses.. 94 % 7.- Willing to attend courses 90.9 % 42% had atended a course: 42.1 % changed his/her practice: Never sedation. > 80 % sedation Previous experience. Increase 50% sedation. L.López Rosés
19 SUMMARY 1.- Significant increase of sedation practices in Spain in the last 20 years. 2.- Propofol is the most widely used sedation drug. 3.- Basic monitoring and recovery rooms are universal. 4.- Specific training courses are of great value, and are demanded by gastroenterologists. 5.- There are some barriers: a) Training of nurses. b) Availability of anaesthesiologists. c) Oposition of anaestehesiologists to the sedation by endoscopists. d) Lack of specific laws / regulations about sedation in Endoscopy. L.López Rosés
20 L.López Rosés
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