Volume 177 - Issue 3
Sedation for endoscopy: the safe use of propofol by general practitioners
Authors: Patricia Mackay and Patrick J Hughes
Med J Aust 2002; 177 (3): 163-165. || doi: 10.5694/j.1326-5377.2002.tb04710.x
Published online: 5 August 2002
Published online: 5 August 2002
To the Editor: Safety is a rather subjective concept, so to use the word without definition, as Clarke et al did,1 is somewhat misleading. One possible definition is that the complication rate for general practitioners is no greater than for anaesthetists in the same circumstances.
In the study by Clarke et al,1 the GPs were allocated the lower-risk cases and the anaesthetists were allocated the more difficult ones. Direct comparison was made without any adjustment for this difference. The data suggest that the GPs had similar or higher rates of adverse events or interventions despite handling lower-risk cases.
The most recent data on anaesthesia-related mortality reports 20 deaths at endoscopy from 1994–1996, with a note that this is likely to be an underestimate.2 Using the authors' denominator of 430 000 endoscopies per year, an estimated risk of anaesthesia-related death is therefore about 1 in 64 000. The risk of anaesthesia-related death for all surgery is quoted as 1 in 63 000, which implies that anaesthesia for endoscopy is of average risk. The sample size of 28 000 lacks sufficient power to make any comment on safety as regards the risk of death.
Although I applaud the clinical standards of the authors' institution and fully agree that propofol has many clinical benefits over other agents, Clarke et al do not prove safety in the use of propofol by non-anaesthetists.
References
- Clarke AC, Chiragakis L, Hillman LC, Kaye GL. Sedation for endoscopy: the safe use of propofol by general practitioner sedationists. Med J Aust 2002; 176: 158-161.
- Davis NJ, editor. Anaesthesia related mortality in Australia 1994–1996. Melbourne: Australian and New Zealand College of Anaesthetists, 1999.
- Clarke AC, Chiragakis L, Hillman LC, Kaye GL. Sedation for endoscopy: the safe use of propofol by general practitioner sedationists. Med J Aust 2002; 176: 158-161. a1
- Knoblanche GE. Sedation for endoscopy [editorial]. Med J Aust 2002; 176: 147. a2
- Australian and New Zealand College of Anaesthetists. Guidelines on conscious sedation for diagnostic, interventional medical and surgical procedures. Melbourne: ANZCA, 2001. (ANZCA Professional Document P9.) Available at: <http://www.anzca.edu.au/pdfdocs/PS9_2001.pdf>.
- Clarke AC, Chiragakis L, Hillman LC, Kaye GL. Sedation for endoscopy: the safe use of propofol by general practitioner sedationists. Med J Aust 2002; 176: 158-161. b1
- Davis NJ, editor. Anaesthesia related mortality in Australia 1994–1996. Melbourne: Australian and New Zealand College of Anaesthetists, 1999. b2
- Australian and New Zealand College of Anaesthetists and Gastroenterological Society of Australia. Sedation for endoscopy. Melbourne: ANZCA, 1997. (ANZCA Professional Document P24.) <http://www.anzca.edu.au/publications/profdocs/professional/P24_1997.htm> (no longer available). b3