Non anesthesia provider providing anesthesia

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I overheard an ED attending discussing a policy regarding the administration of propofol w/ an RN at work today. Apparently the policy states that propofol or any other medication may be administered to a non-intubated pt if an attending ED/Pulmonary physician is in the room. This would be done for a procedure ie: reduction of a fx....etc. I asked him why anesthesia personnel would not provide the anesthesia. He responded that the ED/Pulmonary physician is able to provide all services that anesthesia could. What do you guys think about this?

The cases, which were reported through the Pennsylvania Patient Safety Reporting System, included the following:

A 40-year old patient was admitted with injuries to the face and subarachnoid hemorrhaging. The patient received propofol but was not intubated. While in radiology getting a CT scan, the patient became bradycardic and went into cardiac arrest. The patient was resuscitated but died two days later.

This has got to be the result of medical inbreeding or something.

Who does this kind of crap?

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for whomever asked

13 states prohibit RN admin of diprivan. All the rest allow it apparently.

I wouldn't assume they allow it unless they have a statement explicitly saying they do, as in your state of Arizona. Many states may not have a policy on it since it is clearly outside the RNs realm as an anesthesic agent on a nonintubated pt (as backed up by the package insert).

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This has been informative for me reading the back and forth banter through 7 pages of posts. I'm glad that I was able to generate this kind of response. However, I was hoping to get the official AANA/ASA's official stand on this issue. When I spoke to the ED attending that I referenced in my OP he was of the attitude that anesthesia personnel were not necessary for the administration of anesthetics in this setting. Is there a position that the AANA has? Is there restriction on what the ED docs are able to do?

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Specializes in Anesthesia.
.......I was hoping to get the official AANA/ASA's official stand on this issue. .....

"For Immediate Release

May 5, 2004

AANA-ASA Joint Statement Regarding

Propofol Administration*

April 14, 2004

Because sedation is a continuum, it is not always possible to predict how an individual patient will respond. Due to the potential for rapid, profound changes in sedative/anesthetic depth and the lack of antagonistic medications, agents such as propofol require special attention.

Whenever propofol is used for sedation/anesthesia, it should be administered only by persons trained in the administration of general anesthesia, who are not simultaneously involved in these surgical or diagnostic procedures. This restriction is concordant with specific language in the propofol package insert, and failure to follow these recommendations could put patients at increased risk of significant injury or death.

Similar concerns apply when other intravenous induction agents are used for sedation, such as thiopental, methohexital or etomidate.

*This statement is not intended to apply when propofol is given to intubated, ventilated patients in a critical care setting."

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Specializes in I know stuff ;).

There is no medical restriction. The hospital, in association with its various physician stake holders, make the decision what can and cannot be done where. Where I work anesthesia was consulted and they agreed to allow diprivan use in the ER as long as the ER doc was in the room.

I cant tell you why they did when their organization (ASA these are all MDAs) clearly is against that.

Who knows with hospital politics.

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I was wondering when somebody was getting to let MmcFan know that he is wrong about thiopental having more cardiac depressant effects than propofol. Mmacfan you think you know about these drugs but wait until you get to anesthesia school and you will see what a humbling experience it is. I was one of those people. you think you know critical care, but you get to that OR and you soon discover that you know jack s--t! I watched an attending slam a little eighty old women with 200 of propofol, oops elderly pt forgot to reduce the dose Oh my asystole! Full blown CPR in progress. I was a student when this happened. It is so nice being able to learn from somebody elses mistake.

I must admit that you do keep this BB lively so keep up the good work!

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Specializes in I know stuff ;).

Hey london!

Yes i was already schooled ;)

I wrote without reading first and found out afterward why there is a difference, afterall, what do i know about thiopental? I have never used it.

I love reading the posts, they are informative and i learn alot.

I was wondering when somebody was getting to let MmcFan know that he is wrong about thiopental having more cardiac depressant effects than propofol. Mmacfan you think you know about these drugs but wait until you get to anesthesia school and you will see what a humbling experience it is. I was one of those people. you think you know critical care, but you get to that OR and you soon discover that you know jack s--t! I watched an attending slam a little eighty old women with 200 of propofol, oops elderly pt forgot to reduce the dose Oh my asystole! Full blown CPR in progress. I was a student when this happened. It is so nice being able to learn from somebody elses mistake.

I must admit that you do keep this BB lively so keep up the good work!

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Found in the April Nursing2006 issue:

NAPS is beyond the scope of practice in Florida, Alabama, Arizona, Connecticut, Kentucky, Louisiana, Mississippi, Missouri, South Carolina, Tennessee, Texas, and Wyoming.

NAPS is legal in Maryland, Montana, Nevada, New Hampshire, Oregon, and Washington.

As for the reminder of the US states, the individual states must consider it a non-issue because there is not documentation either for or against NAPS.

Supporters of NAPS are, not suprisingly, the American College of Gastroenterology, the American Gastroenterological Association and the American Society for Gastrointestinal Endoscopy except for high risk patients.

The AANA and ASA consider propofol as a general anesthetic, regardless of the dose.

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[supporters of NAPS are, not suprisingly, the American College of Gastroenterology, the American Gastroenterological Association and the American Society for Gastrointestinal Endoscopy except for high risk patients.

Guess there heads must be up their AS&ES...LOL:lol2:

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Specializes in I know stuff ;).

Hmm

What are NAPS? I know here in AZ diprivan has been approved as long as the facility has a policy. They place it under concious sedation in the hospital, maybe that is a loop hole?

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Nurse administered propofol sedation:

http://www.drnaps.org/index.htm

site hasn't been updated in about 1 1/2 years. perhaps defunct

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Hmm

What are NAPS? I know here in AZ diprivan has been approved as long as the facility has a policy. They place it under concious sedation in the hospital, maybe that is a loop hole?

NAP:

Nurse

Adminstered

Propofol

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