The issue of EDP is controversial. In recent years, the use of Propofol as a form of sedation during endoscopic procedures has increased. The pharmacological effects of Propofol are favorable in comparison to the effects of opioids and benzodiazepines. Opioids are drugs which control pain and two commonly known drugs are Codeine and Morphine. Benzodiazepines are drugs which induce sedation and reduce anxiety and two commonly known drugs in this group are Versed and Valium. Generally, in the United States, Propofol is administered by an anesthesia specialist, which is defined as an anesthesiologist or a certified registered nurse anesthetist.
The controversy focuses on the debate of safety and cost efficiency. The administration of Propofol by an anesthesia specialist significantly increases the total cost of an endoscopic procedure. Anesthesiologists oppose the administration of Propofol by endoscopists claiming that it is unsafe. They cite the warning which is contained in the Propofol package insert that states that this drug should be administered only by persons who are trained in the administration of general anesthesia. It should be noted that this insert was written before evidence, which documented that nonanesthesiologists could administer Propofol safely for endoscopic procedures, was accumulated. (1)
In the October 2009 issue of Gastroenterology, an article, "Endoscopist-Directed Administration of Propofol: A Worldwide Safety Experience" by Douglas K. Rex, et al is featured. The aim of the project was to update the safety experience of EDP and the cost of using anesthesia specialists for endoscopic sedation. The researchers approached this task first by reviewing all published work involving EDP and contacting all endoscopists who they were aware of that performed EDP and obtained their safety experiences. The authors identified limitations in the study such as reliability of the data depended on the reporting of participating centers and the assumptions in cost evaluations.
The data included 646,080 identified cases. All endoscopists who performed the endoscopic procedures and administered or directed the administration of Propofol were gastroenterologists, except for the Australian and Italian groups. All of the 28 centers in the study provided previously unpublished cases. All of these centers required the physicians and nurses to have Advanced Cardiac Life Support certification or an equivalent certificate outside of the United States.
The conclusion on safety was that EDP is as safe as or safer than endoscopist administered opioids and benzodiazepines. Of the 646,080 EDP cases, there were 4 reported deaths and these individuals had serious medical conditions. The supposition of cost efficiency is the use of an anesthesia specialist is costly, $184,778,880 for all 646,080 procedures ($286 per procedure). (2)
(1) www.medscape.com
(2) www.gastrojournal.org
Maryann Gromisch is a registered nurse with clinical experience in medical, surgical, and critical care units. She has worked with a gastroenterologist in a private practice setting.