RESUMO
OBJECTIVE: Only a few reports have addressed non-anesthesiologist-administered propofol for endoscopic ultrasonography (EUS), but none specifically in high-risk patients. Our aim was to study the application of a propofol sedation protocol for EUS in average-risk and high-risk patients. METHODS: This was a prospective observational study including 446 patients referred for EUS. We analyzed the induction time, procedure duration, recovery times, and patients' comfort and safety. Sedation was administered by a trained nurse, under the guidance of the endoscopist. We continuously monitored vital signs as well as patient cooperation and tolerance. Complications, patient, and endoscopist satisfaction were analyzed. RESULTS: No major complications occurred. The rate of minor complications was 9%, the most frequent being hypoxemia (8%). One hundred and thirty-eight high-risk patients were included [American Society of Anesthesiologists (ASA) III-IV]. Average-risk patients received higher propofol doses (202.9 ± 84.8 vs. 164.8 ± 84.3; P=0.003). No differences were found in the rate of complications or procedure-related variables. Overall patient and endoscopist satisfaction was excellent. The logistic regression model identified propofol doses (P=0.02) as a risk factor and ASA-I classification (P=0.03) as a protective factor for the appearance of complications. CONCLUSION: Non-anesthesiologist-administered propofol for upper EUS in high-risk and average-risk patients is safe and could be routinely offered to high-risk and elderly patients.
Assuntos
Sedação Consciente/métodos , Endoscopia Gastrointestinal/métodos , Endossonografia/métodos , Hipnóticos e Sedativos/administração & dosagem , Propofol/administração & dosagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Atitude do Pessoal de Saúde , Sedação Consciente/efeitos adversos , Sedação Consciente/enfermagem , Esquema de Medicação , Endoscopia Gastrointestinal/efeitos adversos , Endossonografia/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Estudos Prospectivos , Medição de Risco/métodos , Fatores de Tempo , Adulto JovemAssuntos
Colangiopancreatografia Retrógrada Endoscópica , Coledocolitíase/diagnóstico , Doenças do Colo/diagnóstico , Fístula/diagnóstico , Doenças da Vesícula Biliar/diagnóstico , Fístula Intestinal/diagnóstico , Coledocolitíase/complicações , Doenças do Colo/complicações , Fístula/complicações , Doenças da Vesícula Biliar/complicações , Humanos , Achados Incidentais , Fístula Intestinal/complicações , Masculino , Pessoa de Meia-Idade , Úlcera Gástrica/complicaçõesRESUMO
Duodenal duplication cysts are rare congenital abnormalities which are more commonly diagnosed in infancy and childhood. However, in rare cases, these lesions can remain asymptomatic until adulthood. The combination of duplication cyst and pancreas divisum is extremely rare and both conditions have been linked with acute recurrent pancreatitis. We present the case of a 37 years-old patient who presented with repeated episodes of acute pancreatitis. By means of magnetic resonance imaging and endoscopic ultrasonography we discovered a duplication cyst whose cavity received drainage from the dorsal pancreas. After opening the cyst cavity to the duodenal lumen with a needle knife the patient presented no further episodes in the clinical follow-up. Comparable literature findings and therapeutic options for these abnormalities are discussed with regard to the presented case.
