Douglas K. Rex, MD, of Indiana University Medical Center and his colleagues analyzed a total of 646,080 EDP cases. Of these cases, 489 resulted in masked ventilation, 11 resulted in endotracheal intubations and four resulted in death. Of the cases resulting in death, all patients were ASA III or higher status, according to the study.
The study found that EDP had a lower mortality rate than that published data on endoscopist-delivered benzodiazepines and opioids and a comparable rate to published data on general anesthesia by anesthesiologists. As a result, the researchers contend that the costs of using anesthesia specialists to deliver propofol would not outweigh any potential benefit.
The study also found that complications for EDP were higher for upper endoscopic procedures than with colonoscopy; none of the four deaths in the study occurred during colonoscopy.
The researchers estimated the cost per life-year saved of substituting anesthesia specialists in the cases, assuming they would have prevented all deaths, was $5.3 million. Thus, the researchers contend that any benefit of reduced complication from using anesthesia specialists would be associated with very high costs.
Read the Gastroenterology study on endoscopist-directed propofol sedation.
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