Gastroenterologists and anesthesiologists are fighting over the use of propofol:
Dr. Edgar Canada, president of the California Society of Anesthesiology, adds that unlike many sedatives, propofol does not have an antidote to reverse unintended effects. The petition by the rival group is “troubling in terms of patient safety,” Dr. Canada says. “Gastroenterologists lack the training and experience.”But gastroenterologists counter that anesthesiologists are just protecting their turf and that the drug is not as risky as they are making it out to be.
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{ 2 comments }
Anesthesia is my area of practice.
It all comes down to who is monioring the patient. The occurance of inadequate breathing is quite common, and someone proficient in monitoring breath to breath and able to effect rapid resolution is essential. The person performing the procedure is in no position to do this.
We use sedation trained nurses, registered-nurse anesthetists, and sedation trained physicians to provide the dedicated monitoring and sedation treatment care for patients undergoing all nature of minimally invasive procedures. Patients are all evaluated by a sedation trained physician and/or anesthesiologist to triage the appropriate level of provider. In no instance the the doctor performing the procedure also perform or monitor the sedation.
Yes, it is about turf. The gastroenterologists want to cash in on the sedation provider fees; that’s a lot of greens fees right there. In our current model the hospital gets most of the sedation fee because hospital employees are providing the sedation service (nurse, CRNA, hospitalist physician). Those patients with poor health status or possible difficult breathing situations are done by me and my fellow anesthesiologists.
As a result of this practice, we have not had the all too common result of a ‘code blue’ in radiology or gastroenterology in two years now. Not many radiology departments can claim 2 weeks between codes.
Having had to fight our anesthesiologists in a bitter turf war for the right to use propofol for procedural sedation in the ER, I am sympathetic to the GI docs. But I have to agree with Gasman. Propofol is not dangerous per se, but I firmly believe that if you are going to put someone down with it you need the skills to ventilate them bag-mask and establish a rescue airway, and GI docs just don’t have that expertise.
And I concur completely with the above about monitoring the patient — when we use it in the ER, we at a minimum have RT there for airway/ventilation and frequently have one ER doc do the sedation and another do the procedure. This is especially the case when the doc doing the procedure is going to be unable to divide his attention between the procedure and the depth of sedation. Not a great practice in the GI lab, I would think.
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