Retrospective observational study on safety of sedation for colonoscopies in ASA I and II patients performed by a nurse and under the supervision of anesthesiology.

INTRODUCTION: Out of operating room sedation with propofol by non-anaesthesiologists (Non Anaesthesiologist Administration of Propofol: NAAP) is a growing practice. This is due to the increase in minimally invasive diagnostic and therapeutic procedures requiring sedation, and the difficulty of anaesthesiology services to respond adequately to this demand. OBJECTIVE: The main objective of this study is to assess the safety of a programme of nurse sedationist-administered target controlled infusion (TCI) of propofol in colonoscopies supervised by anaesthesiologists. MATERIAL AND METHODS: Over a period of 6 months, all ASA I and II patients who required colonoscopy and met the inclusion criteria were included in the study. A total of 381 colonoscopies were performed. Episodes of desaturation, hypo- or hypertension, bradycardia or tachyarrhythmia and the need for anaesthesiology assistance during sedation were analysed. After the procedure, patient satisfaction was assessed on a scale of 1-5, and pain was assessed on a numerical verbal scale of 1-5. RESULTS: A small percentage (5%) of patients presented oxygen saturation of less than 90%, without requiring mask ventilation; 7.35% presented hypotension, 3.94% presented bradycardia, and the supervising anaesthesiologist was called in 22% of cases. Patient satisfaction at the end of the procedure was 4.27 out of 5. CONCLUSION: Sedation during colonoscopy in ASA I and II patients following an agreed protocol can be safely administered by nurse sedationists under the supervision of an anaesthesiologist.

[Premature mortality in the early postoperative period of liver transplantation]. / Mortalidad precoz en el postoperatorio inmediato del trasplante hepático.

OBJECTIVES: To analyze the relation between premature death and complications that develop in the early postoperative period after liver transplantation. MATERIAL AND METHODS: Liver transplants performed in adults in our hospital were reviewed retrospectively. Patients were distributed in 2 groups, those who died and those who survived the early recovery period, and the incidences of complications in the two groups were compared using a chi 2 for single variables and logistic regression for multiple variables. RESULTS: In the 827 liver transplants studied, the recipient died in 86 cases, 7 inside the operating room (0.85%) and 79 during recovery (9.63%), for an overall mortality rate of 10.4% for surgery and the immediate postoperative period. Complications that were significantly different with respect to mortality in the multivariant analysis were post-reperfusion syndrome, atrial fibrillation, acute renal failure, and infection. CONCLUSIONS: Only one of the complications was specific to liver transplantation: post-reperfusion syndrome. The others were of the type found in any critically ill patient, an nearly all led to an increase in infections, which is the most common reason for death during surgical recovery.