Re: Using Propofol for conscious sedation Originally Posted by swolfe_2 
I am not disputing what MAC means.... As the link states, its not just for billing. In AZ both our hospital and outpatient surgery center policies clearly define that the use of propofol in a procedural setting requires "Monitored Anesthesia", because the training is not universal. We had an incident just last week when our anesthesiologist instructed our circulator to push 40 of diprivan during a lumbar pain block and VS were only taken twice during the 40 min procedure, pt was prone, no anesthesia cart, no airway available. She was unfamiliar with the drugs and gave it anyway, and anesthesia had it "under control". The patient was fine (it's not a question of skills) but her medical record is not. There is a plethera of evidence based practice utilizing these meds however the education is drastically different throughout the specialties of our profession. Mistakes will be minimized if the issue is more black and white instead of gray. Of course, CRNA experiences are on a more advanced level.
The whole idea behind MAC was so anesthesia providers could provide and be reimbursed for conscious/moderate sedation. The term/definiton was introduced for the purpose of providing a way for anesthesia providers to be reimbursed for a service that we do quite often, but that insurance companies do not want to pay for. FYI: A lot of insurance companies still won't pay for MAC so another term that is used quite often instead of MAC is total IV anesthetic/TIVA.
See excerpt below from the ASA on MAC:
"Because monitored anesthesia care is a physician service provided to an individual patient and is based on medical necessity, it should be subject to the same level of reimbursement as general or regional anesthesia. Accordingly, the ASA Relative Value Guide provides for the use of proper basic procedural units, time units and age and risk modifier units as the basis for determining reimbursement.*"
Here is few reference ariticles on nurse administered propofol sedation.
Aisenberg J, Cohen LB, Piorkowski JD, Jr. (2007). Propofol use under the direction of trained gastroenterologists: an analysis of the medicolegal implications. American Journal of Gastroenterology, . 102(4), 707-713.
Akin A, Guler G, Esmaoglu A, Bedirli N, A B. (2005) A comparison of fentanyl-propofol with a ketamine-propofol combination for sedation during endometrial biopsy. Journal of Clinical Anesthesia. (17), 187–190.
Cohen LB, Dubovsky AN, Aisenberg J, Miller KM. (2003). Propofol for endoscopic sedation: A protocol for safe and effective administration by the gastroenterologist. Gastrointestinal Endoscopy, 58(5), 725-732.
Cohen LB, Hightower CD, Wood DA, Miller KM, Aisenberg J. (2004). Moderate level sedation during endoscopy: a prospective study using low-dose propofol, meperidine/fentanyl, and midazolam. Gastrointest Endoscopy, 59(7), 795-803.
Fanti L, Agostoni M, Arcidiacono PG, et al. (2007). Target-controlled infusion during monitored anesthesia care in patients undergoing EUS: propofol alone versus midazolam plus propofol. A prospective double-blind randomized controlled trial. Digestive and Liver Disease, 39(1), 81-86.
Fanti L, Agostoni M, Casati A, et al. (2004). Target-controlled propofol infusion during monitored anesthesia in patients undergoing ERCP. Gastrointestinal Endoscopy, 60(3), 361-366.
Gasparovic S, Rustemovic N, Opacic M, et al. (2006). Clinical analysis of propofol deep sedation for 1,104 patients undergoing gastrointestinal endoscopic procedures: a three year prospective study. World Journal of Gastroenterology, 12(2), 327-330.
Harrington L. (2006). Nurse-administered propofol sedation: a review of current evidence. Gastroenterology Nursing, 29(5), 371-383; quiz 384-375.
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