Gut Check on Gastroenterology Archive

Propofol is a remarkable drug that has revolutionized sedation for patients undergoing endoscopic procedures. It can produce rapid and, when necessary, deep sedation, and its effects can be reversed within seconds to minutes. Because it has proven to be more effective than hypnotics (such as versed) and narcotics (such as fentanyl), an estimated 40% of all endoscopic sedation in the U.S. is now being performed with propofol.

Unfortunately, because propofol is labeled an anesthetic, GI docs in most hospital endoscopy units are blocked from using the drug by the hospitals’ anesthesia departments, which set sedation policies. Such policies persist, largely because of ongoing turf wars, despite documentation of more than 500,000 cases of safe propofol administration by nurses under GI-doc supervision.

Given the restrictions on propofol use, many endoscopists have resorted to calling in anesthesiologists or anesthetists to administer the drug in routine cases. But does this response meet the highest standards of professionalism? In my opinion, the turf war is wrong, but it does not justify introducing the cost of an anesthesia provider into routine endoscopic procedures.

I suspect many of you have strong opinions about this one way or the other, so please weigh in on the subject.