Quote from Tenesma
and first of all, i would be very careful using propofol/etomidate for a MAC as their use can quickly convert the case to a GA:
While this is an important point, I am a bit puzzled that you would emphasize it in this discussion. The OP is a SRNA, and learning to provide MAC anesthesia care. I don't think the question was about using this mix in non-anethesia provider deep/conscious sedation cases.
The possibility for tipping the scale to a general is always present when providing this type of anesthesia. Perhaps you wanted to emphasize that this is more likely when you mix these two particular drugs. If so-then point taken.
However, don't we use polypharmacy all the time? In fact, I think that might be one of our particular strengths as anesthesia specialists-the knowledge and expertise to devise particular cocktails to suit particular needs.
And there are so many choices at our disposal, it is quite unlikely that any one provider will find them all useful. What works in my hands may not be a good technique for another. I believe it is a good attribute in an anesthesia professional to keep an open mind about these things. (Of course, there is no need to try a technique that one has misgivings about, based on one's knowledge of anesthesia, so if Tenesma and mwbeah judge this particular combination to be undesirable, that is certianly a valid opinion).
As to the original question, I have no experience with the combination of propofol and etomidate. However, the goals the OP describes for using this mix remind me of another MAC technique that has a similar profile-propofol and ketamine, preceeded by a little versed to counteract any ketamine-creepiness. Propofol ketamine is widely used in plastics and other MAC situations where fairly profound sedation is required, but there may be less than ideal access to the airway. I believe it to be a more accepted choice, that might be a suitable alternative for some cases. It is especially useful when you need its analgesia properties.
GI lab-those cases usually don't cause much pain. I too would go with straight propofol in those settings. I have found that even fentanyl and/or versed just add to recovery time, without changing procedure conditions very much.