I agree with the majority of your post. More research does need to be done. Propofol does facilitate the procedure and should be more widely used in CRC screenings. We are talking about a practice that should only be attempted by highly trained practitioners.
I think it is erroneous to draw the conclusion that if a state nursing board does or does not allow a practice, it is an indicator of what should be happening. As part of my job as an anesthesia consultant, providing training and CE for physicians, nurses, dentist etc... and assisting with the development of sedation programs for facilities, I communicate with state dental, medical and nursing boards across the country on a daily basis. Their job is to protect the public - that's it, and that is all they want to do. It is up to the practitioners to reach a consensus as to what the policy should be, not the state boards, you will never get a unanimous decision from 50 states on anything, nor should you.
I'm not familiar with any "weekend Vegas courses" that certify gastroenterologists in anesthesia, but the main thing would be for them to have sufficient training and skill in airway management, better yet it makes more sense for the nurse to have the airway management skills.
The propofol package insert clearly states:
For general anesthesia or monitored anesthesia care (MAC) sedation, DIPRIVAN Injectable Emulsion should be administered only by persons trained
in the administration of general anesthesia and not involved in the conduct of the surgical/diagnostic procedure. Patients should be continuously
monitored, and facilities for maintenance of a patent airway, artificial ventilation, and oxygen enrichment and circulatory resuscitation must be immediately
For sedation of intubated, mechanically ventilated adult patients in the Intensive Care Unit (ICU), DIPRIVAN Injectable Emulsion should be administered
only by persons skilled in the management of critically ill patients and trained in cardiovascular resuscitation and airway management.
If the Dr. is doing the procedure, it is up to the nurse to monitor the patient (see underlined above)
Now one would probably point out the first part of that statement that says " should be administered only by persons trained in the admin of GA" but upon closer look that is for general anesthesia and mac sedation. For a colonoscopy we are talking about conscious sedation (remember the continuum) Not to mention the fact that if you look up how many anesthesia providers there are in this country and divide that by the number of procedures done using propofol each year, you will have a better understanding of the problem.
We need more nurses who are competent enough to administer this drug safely, that is done through training and continuing education.
That's my soapbox opinion.