GI Physicians Endorse Propofol
Use; ASA to Issue Statement
In October 2003, the ASA Committee
on Ambulatory Surgical Care submitted an annual
report to the ASA House of Delegates, examining
an ongoing controversy about who should be allowed
to administer propofol for medical and surgical
procedures, including colonoscopies and endoscopies.
In the report (611-1), the Committee on Ambulatory
Surgical Care summarized the level of concern as
of August 2003:
“A growing issue in ambulatory surgery is
the administration of propofol for sedation by nonanesthesia
providers. Typically this consists of drugs administered
and monitored by a registered nurse under the supervision
of the procedural physician. …"
“Whenever propofol is used, for general anesthesia
or for sedation, it should be administered only
by persons trained in the administration of general
anesthesia. It is important that these persons are
not simultaneously involved in the conduct of the
surgical or diagnostic procedure. In addition, these
persons must monitor patients continuously for oxygen
saturation, respiration, heart rate and blood pressure.
Facilities must be immediately available for the
maintenance of a patent airway, oxygen enrichment
and artificial ventilation in addition to circulatory
resuscitation."
“The location of service does not need to
be limited, as long as the above criteria for qualified
persons administering the drug, monitoring the patients
and appropriate equipment are met."
“In addition, some states have prescriptive
regulations concerning the administration of propofol.
There are different considerations when propofol
is given to intubated, ventilated patients in a
critical care setting.”
More recently, Committee Chair Beverly K. Philip,
M.D., said her committee is close to finalizing
a formal statement that addresses the issue, including
the question of how to define “rescue.”
The committee’s position statement will go
to the ASA Board of Directors for review and possible
approval in August.
In addition, the American Association for Accreditation
of Ambulatory Surgery Facilities (AAAASF) has changed
its standards and, as of March 1, 2004, requires
that only anesthesiologists or nurse anesthetists
administer propofol. This follows AAAASF’s
evaluation of reports of several patient deaths
that occurred in facilities “without adequate
resuscitation equipment and/or personnel airway
management training.” The AAAASF <www.aaaasf.org>
currently accredits approximately 1,100 facilities.
On March 8, three GI doctors’ organizations
put out a statement
supporting nurse-administered propofol sedation
(NAPS) by specially trained gastroenterology nurses.
These nurses, however, are not trained in the administration
of general anesthesia. The statement was the product
of a six-member committee composed of representatives
from each of the three societies: American College
of Gastroenterology, American Gastroenterological
Association and American Society of Gastrointestinal
Endoscopy. It has been reported that the Society
for Gastroenterology Nurses and Associates plans
to release a similar statement in the next few months.
For additional information on ASA’s position
on the subject of sedation by nonanesthesiologists,
see the ASA “Practice Guidelines for Sedation
and Analgesia by Nonanesthesiologist,” http://www.asahq.org/publicationsAndServices/sedation1017.pdf
. This practice parameter, revised in
2001 and published in the journal Anesthesiology
(April 2002), was endorsed by the American Society
for Gastrointestinal Endoscopy (ASGE) as well as
the American College of Radiology and the American
Association of Oral and Maxillofacial Surgeons.
A related ASA statement on Continuum of Depth of
Sedation is also available on the ASA Web site:
http://www.asahq.org/publicationsAndServices/standards/20.htm
To read the statement, go to:
www.gastro.org/media/newsRelease04/statement-SedationEndoscopy.html
Posted: 3/30/04