A212 ENDOSCOPIST-DIRECTED PROPOFOL AS AN ADJUNCT TO STANDARD SEDATION: A CANADIAN EXPERIENCE
Bibliographic record
Abstract
Sedation practices vary widely by region. In Canada, endoscopist-directed administration of a combination of fentanyl and midazolam is standard practice, with only a minority of cases performed with propofol. To demonstrate the safety of non-anesthetist administered propofol for endoscopic sedation. This was a single-centre retrospective cohort study of patients having undergone endoscopic procedures with propofol sedation between 2004 and 2012 in an academic hospital in Montreal. Procedures were performed by gastroenterologists trained in Advanced Cardiovascular Life Support. Sedation was administered by IV bolus by a registered nurse, under the direction of the endoscopist. Outcomes of procedures were collected using the hospital’s endoscopy database. 4955 patients were included. Cecal intubation rate for colonoscopies (n=2920) was 90.0%. Gastroscopies (n=1625), flexible sigmoidoscopies (n=28), ERCP (n=341) and PEG insertion (n=41) had success rates of 98.4%, 96.4%, 94.4% and 92.7% respectively. The average dose of propofol used for each procedure was 34.6 mg. Fentanyl was used in 68% of procedures at an average dose of 94.4 mcg. Versed was used in 92.9% of cases at an average dose of 3.0 mg. Reversal agents (naloxone or flumazenil) were used in 0.4% of cases (n=21). Patients having received reversal agents were discharged uneventfully within the usual post-procedure recovery time. One patient required transfer to the ER. Most patients having received propofol in addition to standard sedation agents experienced no adverse events (99.6%). There were no deaths. The use of propofol administered by a registered nurse under the direction of the endoscopist as an adjunct to fentanyl and versed is safe and effective. None
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.006 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.003 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".