ABSTRACT
Introducción: existe evidencia de que un equipo formado por endoscopista y enfermera puede hacerse cargo de la sedación de un paciente con propofol de forma eficaz, segura y eficiente. Para ello, es fundamental una adecuada formación y entrenamiento específico que les otorgue las competencias necesarias. El objetivo principal de este estudio fue realizar, tras un año de implantación, una evaluación de la calidad del procedimiento de sedación administrada por personal no anestesiólogo en una unidad de endoscopia digestiva. Métodos: se realizó un estudio de cohortes prospectivo sobre los pacientes que recibieron sedación con propofol por personal no anestesiólogo. Posteriormente, se seleccionó una muestra aleatoria de registros clínicos para evaluar la adherencia de los profesionales a diferentes criterios de calidad, así como la aparición de eventos adversos relacionados con la sedación. Resultados: en el periodo de estudio se realizaron un total de 595 procedimientos bajo sedación con propofol. La tasa de eventos adversos fue del 2,4% (n = 507), principalmente episodios de hipotensión e hipoxemia. Los porcentajes de adherencia al procedimiento de sedación se situaron por encima del 80% en la mayoría de los criterios, aunque fue menor en la cumplimentación de la valoración del riesgo ASA. Conclusión: los resultados del estudio sugieren que el propofol puede ser administrado con seguridad y eficacia por un equipo cualificado de endoscopista y enfermera, en pacientes con un riesgo ASA I-II. Las auditorías sobre la adherencia de los profesionales al procedimiento permiten identificar necesidades de mejora para poder seguir trabajando sobre aspectos aún no consolidados
Introduction: research has shown that an endoscopist-nurse clinical team can perform sedation with propofol effectively, safely and efficiently. To do so, it is essential to provide specific and appropriate training in the necessary skills. The main aim of the present study was to evaluate the quality of the sedation procedure administered by non-anesthetists in a digestive endoscopy unit, one year after its introduction. Methods: a prospective cohort study was performed in patients given propofol sedation by non-anesthetists. Subsequently, a random sample of clinical records was selected in order to evaluate the adherence of professionals to the quality criteria and to assess the rate of adverse events related to sedation. Results: a total of 595 procedures were performed under propofol sedation during the study period. The rate of adverse events was 2.4% (n = 507), mainly involving hypotension and hypoxemia. Adherence to the sedation procedure was above 80% for most of the applicable criteria, although it was lower for the completion of ASA risk evaluation. Conclusions: the results of the study suggest that propofol can be administered safely and effectively by a qualified endoscopist-nurse team, in patients with an ASA I-II risk. Audits of adherence by medical staff to the recommended procedure facilitate the identification of areas for improvement; further work is needed on the aspects that have not yet been consolidated
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Conscious Sedation/methods , Endoscopy, Gastrointestinal/methods , Propofol/adverse effects , Hypnotics and Sedatives/adverse effects , Conscious Sedation/adverse effects , Cohort Studies , Endoscopy, Gastrointestinal/nursing , Prospective StudiesABSTRACT
INTRODUCTION: research has shown that an endoscopist-nurse clinical team can perform sedation with propofol effectively, safely and efficiently. To do so, it is essential to provide specific and appropriate training in the necessary skills. The main aim of the present study was to evaluate the quality of the sedation procedure administered by non-anesthetists in a digestive endoscopy unit, one year after its introduction. METHODS: a prospective cohort study was performed in patients given propofol sedation by non-anesthetists. Subsequently, a random sample of clinical records was selected in order to evaluate the adherence of professionals to the quality criteria and to assess the rate of adverse events related to sedation. RESULTS: a total of 595 procedures were performed under propofol sedation during the study period. The rate of adverse events was 2.4% (n = 507), mainly involving hypotension and hypoxemia. Adherence to the sedation procedure was above 80% for most of the applicable criteria, although it was lower for the completion of ASA risk evaluation. CONCLUSIONS: the results of the study suggest that propofol can be administered safely and effectively by a qualified endoscopist-nurse team, in patients with an ASA I-II risk. Audits of adherence by medical staff to the recommended procedure facilitate the identification of areas for improvement; further work is needed on the aspects that have not yet been consolidated.
Subject(s)
Conscious Sedation/methods , Endoscopy, Gastrointestinal/methods , Hypnotics and Sedatives , Propofol , Adult , Aged , Aged, 80 and over , Cohort Studies , Conscious Sedation/adverse effects , Female , Humans , Hypnotics and Sedatives/adverse effects , Male , Middle Aged , Nurses , Propofol/adverse effects , Prospective StudiesABSTRACT
BACKGROUND: Preoperative anxiety is a frequent and challenging problem with deleterious effects on the development of surgical procedures and postoperative outcomes. To prevent and treat preoperative anxiety effectively, the level of anxiety of patients needs to be assessed through valid and reliable measuring instruments. One such measurement tool is the Amsterdam Preoperative Anxiety and Information Scale (APAIS), of which a Spanish version has not been validated yet. OBJECTIVE: To perform a Spanish cultural adaptation and empirical validation of the APAIS for assessing preoperative anxiety in the Spanish population. METHODS: A two-step forward/back translation of the APAIS scale was performed to ensure a reliable Spanish cultural adaptation. The final Spanish version of the APAIS questionnaire was administered to 529 patients between the ages of 18 to 70 undergoing elective surgery at hospitals of the Agencia Sanitaria Costa del Sol (Spain). Cronbach's alpha, homogeneity index, intra-class correlation coefficient, and confirmatory factor analysis were calculated to assess internal consistency and criteria and construct validity. RESULTS: Confirmatory factor analysis showed that a one-factor model was better fitted than a two-factor model, with good fitting patterns (root mean square error of approximation: 0.05, normed-fit index: 0.99, goodness-of-fit statistic: 0.99). The questionnaire showed high internal consistency (Cronbach's alpha: 0.84) and a good correlation with the Goldberg Anxiety Scale (CCI: 0.62 (95% CI: 0.55 to 0.68). CONCLUSIONS: The Spanish version of the APAIS is a valid and reliable preoperative anxiety measurement tool and shows psychometric properties similar to those obtained by similar previous studies.
