• G Martínez Palli, M Ubré, E Rivas, A Blasi, X Borrat, R Pujol, R P Taurà, and J Balust.
• Servicio de Anestesiología y Reanimación, Sección del Instituto de Enfermedades Digestivas, Hospital Clinic de Barcelona. gmartin@clinic.ub.es
• Rev Esp Anestesiol Reanim. 2011 Aug 1; 58 (7): 406-11.

Background And ObjectiveThe growing demand for digestive and other endoscopic procedures outside the operating room, both in terms of type of endoscopy and number of patients, requires reorganization of the anesthesiology department's workload. We describe 2 years of our hospital digestive endoscopy unit's experience with a now well-established care model involving both anesthesiologists and nurse anesthetists.Material And MethodsAfter previously reviewing the medical records of outpatients and conducting a telephone interview about state of health, nurse anesthetists administered a combination of propofol and remifentanil through a target-controlled infusion system under an anesthesiologist's direct supervision.ResultsThe ratio of anesthesiologists to nurses ranged from 1:2 to 1:3 according to the complexity of the examination procedure. Over 12000 endoscopies (simple to advanced) in a total of 11853 patients were performed under anesthesia during the study period. Airway management maneuvers were required by 4.9% of the patients; 0.18% required bag ventilation for respiratory depression, and 0.084% required bolus doses of a vasopressor to treat hypotension or atropine to treat bradycardia. The procedure had to be halted early in 9 patients (0.07%). No patient required orotracheal intubation and none died. Nor were any complications related to sedation recorded.ConclusionThe results suggest that this care model can safely accommodate a large caseload in anesthesia at an optimum level of quality.

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