Nurses Pushing Propofol for Conscious Sedation -Your Thoughts?

Do a search. There is a very long thread from the past on this subject that will give you all the info you could ever want.

There are numerous studies on nurse administered propofol sedation/NAPS. My group actually did our Masters research project/literature review comparing different sedation strategies in the GI clinic with and without the use of propofol.

The last I knew there were about 22 states that allowed RNs(not CNRAs) to administer propofol for moderate sedation. The research is overwhelming in the consensus that NAPS is safe under the right conditions/dosages.

Is there something particular you are wanting to know?

I asked a similar question in my post "lower endoscopy usual practice". I discussed conscious sedation practices for colonoscopy and I was surprized at the opinions that I got; I was mainly interested in unsedated exams but got a lotof info on propofol. The Chief GI doc said that patients overwhelmingly preferred propofol to the benzo/narcotic combination, but they didn't do many cases with propofol because it required a CRNA to push it and that added an unreasonable amout of money to the bill. He also said that it was often difficult to keep things on schedule because they were constantly waiting of the CRNA to show up to administer the drug. What surprized me was his opinion that a patient deeply sedated (ie with propofol) is more likely to get perforated that a lightly sedated or unsedated patient. Nurses are not permitted to push propofol in our hospital; a while back one of the CRNA's was telling me that the new drug fospropofol may be approved to be administered by non-CRNA's...which makes little sense to me since fospropofol is metabolized into propofol.

Fospropofol still has the same labeling that propofol has ie. not to be used for sedation by non anesthesia providers.
I have heard the same thing about higher potential for bowel perforation from another GI physician, but just because you give propofol doesn't mean it has to be deep sedation. You can titrate propofol to give any level of sedation you want. Most anesthesia providers are very comfortable with deep sedation, so we often choose deep sedation over moderate sedation. Deep sedation is often easier to deal with/obtain than moderate sedation.

lol...I am military trained CRNA. Here is my reference list. Take a look at the meta-analysis by Qadeer and then there is another article by Walker et al. where an anesthesiologist set up sedation training for nurses and they did a 4yr prospective study on over 9K patients.

References
American Association of Nurse Anesthetists & American Society of Anesthesiologists (Producer). (2004). AANA & ASA Joint Statement on Nurse Administered Propofol Sedation [Video file]. Retrieved from http://www.aana.com/news.aspx?ucNavM...a+asa+propofol
American Association of Nurse Anesthetists (1996). Considerations for Policy Guidelines for Registered Nurses Engaged in the Administration of Sedation and Analgesia . Retrieved March 28, 2008, from http://www.aana.com/resources.aspx?u...enuID=6&id=706
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