[genbytu]

Т.о. пациент получил "положительную" информацию от всех вас, "отрицательную" - от меня.

В чем заключалась "отрицательная" информация? В Ваших домыслах? Где объективное подтверждение Ваших слов?

И самостоятельно принял решение. Если мои доводы оказались для него более убедительными или более соответствуют реалиям медпомощи в его городе, то при чем тут я?

При том, что Ваши суждения ошибочны и субъективны, а Ваше вмешательство в тему с категоричными высказываниями привело к формированию у пациента ошибочного мнения в опасности процедуры.

Пока что вы занимаетесь только тем, что пререкаетесь со мной.

Лично я дискутирую, а не пререкаюсь, причем стараюсь представлять объективные данные.

Внутривенная анестезия при ФГДС и комфортна, и безопасна - при должном оснащении, лекарственном обеспечении, наличии квалифицированного персонала, достаточного времени для наблюдения и т.д. и т.п.

Советую перечитать гайдлайн и ознакомиться со статьями в PubMed, думаю после внимательного прочтения Ваше мнение изменится. Ничего особенного, кроме желания, для проведения наркоза в данных ситуациях не требуется.

Ссылки? Откройте инструкцию к препаратам для анестезии: большинство из них угнетает глоточные рефлексы, а тот, что не угнетает - далеко не комфортен.

Найдите исследование, которое показывает повышенный риск аспирации при выполнении данных исследований под наркозом, при всем своем желании, я не нашел.
Думаю Вам будет полезно почитать данный топик
Кроме того, советую почитать следующие статьи.

Endoscopist-administered propofol: a retrospective safety study.
Morse JW, Fowler SA, Morse AL.
Source
Stanton Territorial Hospital, Yellowknife, Canada.
Abstract
BACKGROUND:
Propofol is an anesthetic agent that is commonly used for conscious sedation. Propofol has advantages as a sedative agent for endoscopic procedures including rapid onset, short half-life and rapid recovery time. However, concerns exist regarding the potential for respiratory depression, hypotension, perforation due to deep sedation and the need for monitoring by an anesthetist. Propofol has been used under endoscopist supervision at the Stanton Territorial Hospital in Yellowknife, Northwest Territories since 1996 (approximately 7000 cases).
METHODS:
A retrospective chart review of endoscopic procedures conducted at the Stanton Territorial Hospital between January 1996 and May 2007 was performed. A random sample of 680 procedures was reviewed from a total of 6396 procedures.
RESULTS:
The mean (+/- SD) baseline systolic blood pressure (SBP) was 122.8+/-17.0 mmHg. The mean lowest SBP was 101.7+/-14.5 mmHg. The mean absolute drop in SBP was 21.1+/-16.7 mmHg, with a mean per cent drop of 16.3%+/-11.7%. Eighty-eight patients (12.9%) developed transient hypotension (SBP lower than 90 mmHg). All patients regained normal blood pressure spontaneously on repeated measurement. No patients required intravenous fluid resuscitation. The mean O2 saturation was 96.4%+/-2.1%. One patient (0.1%) transiently desaturated (O2 saturation 89%), but recovered spontaneously on repeat measurement with no intervention. No procedures were aborted for patient safety. There were no major complications, including perforation or death. There was one mucosal tear during nontherapeutic colonoscopy (0.1%).
CONCLUSIONS:
Propofol can be safely administered in a community hospital setting under endoscopist supervision, with no additional support or monitoring.

[Ссылки доступны только зарегистрированным пользователям ]
[Ссылки доступны только зарегистрированным пользователям ] интереснейшее обсуждение вопроса, крайне рекомендую.

Практикующему анестезиологу этот тезис доказывать не надо.

Немного не в тему, но тоже интересно. Речь о том, что эндоскопист сам может вводить пропофол во время процедуры.

A randomized controlled trial of endoscopist vs. anaesthetist-administered sedation for colonoscopy.
Poincloux L, Laquière A, Bazin JE, Monzy F, Artigues F, Bonny C, Abergel A, Dapoigny M, Bommelaer G.
Source
Clermont University, Auvergne University, Clermont-Ferrand, France.
Abstract
BACKGROUND:
Endoscopist-administered propofol sedation for colonoscopy has not been compared to anaesthetist-administered deep sedation in clinical trials. Our aim was to compare patients' satisfaction and safety during these two sedation modalities.
METHODS:

90 adult patients undergoing colonoscopy were randomized into Group A, Endoscopist-administered propofol sedation and Group B, anaesthetist-administered deep sedation. Group A patients received an initial dose of 30-50 mg of intravenous propofol; additional doses were injected by the endoscopist using a pre-programmed pump. Global satisfaction was measured on a 0-100 mm visual analogue scale.
RESULTS:

The average satisfaction scores after examination completion amongst group were not statistically different (90.8 mm for Group A vs. 89 mm for Group B). Group A patients expressed more frequently a good level of satisfaction (95% vs. 75%; p=0.03) and willingness to undergo further colonoscopies under the same conditions (95% vs. 79%; p=0.02). Total duration time and procedural difficulty did not differ between the groups. Group A received a lower total propofol dose than Group B (94 mg vs. 260 mg) and experienced fewer side-effects (16 vs. 3, respectively; p < 0.008).
CONCLUSION:

Endoscopist-administered propofol sedation for colonoscopy offered a better level of satisfaction and fewer side-effects than anaesthetist-administered deep sedation.

Endoscopist administered propofol for upper-GI EUS is safe and effective: a prospective study in 500 patients.
Yusoff IF, Raymond G, Sahai AV.
Source
Department of Gastroenterology, Centre Hospitalier de l'Université de Montréal-Hôpital Saint Luc, 1058 Rue St. Denis, Montréal, Québec H2X 3J4, Canada.
Abstract
BACKGROUND:
The administration of propofol for endoscopic sedation by a qualified person, other than the endoscopist, is safe and effective. The aim of this study was to determine if propofol can be administered safely and effectively by the endoscopist performing the procedure.
METHODS:
All patients referred for upper-GI EUS were eligible for inclusion in the study. Exclusion criteria included the following: age less than 18 years, American Society of Anesthesiology physical status class greater than 2, a potential for difficulty in airway maintenance, and allergy to propofol constituents. The endoscopist administered propofol as an intravenous bolus followed by a constant infusion. Adverse events, drug dosage, complications, and patient/endoscopist satisfaction were recorded.
RESULTS:

A total of 500 patients (285 women, 215 men; mean age 53.4 [14.8 years]) were enrolled. Mean propofol dose was 301 mg (range 100-1000 mg). Mean procedure time was 19 minutes (range 3-70 minutes). The required examination was completed in all cases. There was no major adverse event. Oxygen desaturation (oxygen saturation < 95%) occurred in 16 (3%) patients. There were 4 (1%) cases of mild hypoxemia (saturation < 90%) but no case of severe hypoxemia (saturation <85%). The endoscopist rated the 92% of the procedures as "very smooth" or "smooth" and regarded administration of propofol as "easy" for 92%. All patients said they would prefer the same method of sedation if the procedure were repeated.
CONCLUSIONS:
Endoscopist-administered propofol is safe and effective in selected patients