December 29, 2005
The
following letter from ASA President Orin F. Guidry,
M.D. has been submitted to the Wall Street Journal
in response to a December 27 article by Vanessa
Fuhrmans, “Making Colonoscopies More Comfortable.” (For
a summary of the article, click here) |
To
the Editor:
I
am writing in response to the December 27th article
by Vanessa Fuhrmans, “Making Colonoscopies More
Comfortable,” about the increasing use of the
anesthetic drug propofol for this procedure and the
decision by some health insurance providers not to
pay for an anesthesiologist’s services for routine
colonoscopy.
Members
of the American Society of Anesthesiologists (ASA)
are concerned about patient safety and feel the article
does not go far enough to elucidate the potential risks
of propofol, particularly in untrained hands.
The
public needs to know that propofol is a potent anesthetic
drug that can produce varying and sometimes unpredictable
levels of sedation, including general anesthesia with
loss of breathing control. Only those trained to administer
anesthesia are qualified to recognize potential complications
that may arise and to rescue the patient if necessary.
Recognizing
the potential dangers of this drug in untrained hands,
ASA issued its “Statement on Safe Use of Propofol” in
October 2004, available at www.asahq.org/PublicationsAndServices/standards/37.pdf
The
U.S. Food and Drug Administration recognizes these
dangers as well in a warning on the drug’s package,
indicating that it should only be administered by persons
who are trained in the administration of general anesthesia
and who are not involved in the conduct of the surgical/diagnostic
procedure. When some representatives of the gastroenterology
profession filed a petition with the FDA to have this
warning removed from propofol, ASA submitted a letter
and testimony outlining the reasons that such an action
could endanger patients. These risks were not addressed
in Ms. Fuhrmans’ article. These documents may
be viewed at http://www.asahq.org/news/news111705.htm
Whether
or not an anesthesiologist is medically necessary for
any given procedure, including relatively minor ones,
depends on many factors.
This
issue will grow in importance as the considerable demand
for procedures like colonoscopy increases. Our position
is not about medical politics or healthcare economics.
It is about weighing comfort and convenience versus
safety when using a powerful anesthetic drug in the
absence of the medical professional who is properly
trained to care for the patient.
Sincerely,
Orin F. Guidry, M.D.
President
American Society of Anesthesiologists