Interventional gastroenterology

Gastroenterologists back anaesthetic guidelines

Australian gastroenterologists have reaffirmed their support for national anaesthesia guidelines that require properly qualified doctors to supervise the administration of anaesthetic drugs to patients undergoing endoscopies.

This follows the revelation by ABC News that nurses at The Canberra Hospital have been administering anaesthetic drugs without supervision during endoscopies for more than a decade, in contravention of the Australian College of Anaesthetists’ guidelines.

The report’s author, Victorian anaesthetist Dr Simon Hendel, who works with the ABC’s 7.30 Report, said it had been confirmed that nurses administered drugs in The Canberra Hospital’s gastroenterology suites, from 2000 to 2016.

“The drugs included the potent anaesthetic drug propofol, as well as the strong sedatives fentanyl and midazolam,” he wrote.

“Under the guidelines, the use of propofol for general anaesthetic or sedation should be reserved for anaesthetists or doctors with specialised training, who are solely responsible for the sedation.

“Guidelines state that “deeper sedation or general anaesthesia must not be used unless an anaesthetist, or other trained and credentialed medical practitioner within his/her scope of practice, is present”. Where such a practitioner is not present, propofol must not be used.”

Dr Hendel said 7.30 had been told nurses at The Canberra Hospital did not receive specific training or accreditation for sedation from the anaesthesia department. The practice, known as Endoscopist-Directed-Nurse-Administered-Propofol-Sedation (EDNAPS), is reportedly common in some parts of Europe and the United States but is not accepted practice in Australia, due to different levels of relevant nurse-training and concerns about safety, he said.

He reported that ACT Health says the practice has now stopped at the hospital.

Gastroenterological Society of Australia (GESA) honorary secretary and gastroenterologist Dr Katie Ellard told the limbic that while the guidelines were not enforceable, they were accepted practice and it was recommended that they be followed.

“We really thing at this stage it is inappropriate to vary from practice of the guidelines,” she said. “I don’t think there is anything new here for gastroenterologists. At the moment we are not going away from existing guidelines from the College of Anaesthetists.”

However she said that there could realistically be situations where medical emergencies might require “variation” from guidelines, such as in cases where there were no anaesthetists available to assist.

“We haven’t got a picture of what goes on in public hospitals – there may be variations in guidelines,” she said.

“The aim of the game must always be to provide the best possible care. I’m sure it happens (diversion from the guidelines), but one met call is not a red flag that there is a problem in the unit by any means.”

President of the Australian Society of Anaesthetists, Associate Professor David Scott, was less forgiving, telling the ABC it was misleading to refer to EDNAPS as “sedation” because the combination of fentanyl, midazolam and propofol could quickly progress to general anaesthesia.

“This is very dangerous practice and strictly forbidden in all the major guidelines,” he said. “It’s playing with patients’ lives to save a few dollars.”

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