Mr. Lynch discusses some of the clinical and business benefits of using propofol at ASCs and why the use of the drug isn’t more widespread.
Q: What are some the clinical and business benefits of administering propofol?
Sean Lynch: Keeping in mind that I am not a physician, I understand the biggest clinical benefit of propofol to be that it is non-hallucinogenic, unlike most other drugs administered during short procedures, such as quick arthroscopies or GI procedures. Propofol is administered, which essentially puts the patient to sleep, and this is done in concert with other drugs, such as regional blocks, to reduce pain. Because it is a non-hallucinogenic, patients recover more quickly, which aids in turnover time and gets the patients home more quickly. It doesn’t give you the side effects other drugs do. Also, the patient actually remembers instructions or other information you tell them before discharge, which decreases the likelihood that he or she will call the office with questions, allowing a center to be more efficient. Using CRNA-administered propofol also reduces the amount of people required to be in the OR, because a CRNA fills the requirement for a monitoring nurse. A center only needs to provide a tech for the physician, which is a cost savings.
Q: Propofol is often used in GI procedures, such as colonoscopies. However, not all GI centers use the drug. Why?
SL: Propofol has to be administered by someone trained in anesthesia. Although many GI physicians are trained in this area, that training might have occurred 20-30 years earlier. GI physicians may not comfortable administering propofol and performing the GI procedure at the same time. Therefore, GI physicians may choose to administer their own anesthetics, such as Valium or Versed. However, these drugs don’t allow a patient to go into deep sedation, which can increase patient comfort, especially during procedures like colonoscopies. The use of anesthesiologist- and CRNA-administered propofol can increase the productivity of a GI physician up to 30-35 percent. The physician can concentrate on the GI procedure, and the anesthesia staff takes over PACU care. Turnover time can go from 30 minutes down to 15 minutes or less, and the physician can treat more patients, allowing them to be more profitable. The cost of propofol is a bit higher than other anesthetics, but that cost is recouped by reduced staffing costs and increased profitability.
Q: Recent studies, though, have suggested that GI physicians can safely administer propofol. Should we be cautious about the findings, then?
SL: Propofol provides a deep, deep sedation. It is a full anesthetic. With that, the airway can become restricted. When people administering propofol are not trained in airway management, you are getting into a dangerous area. The physician needs to be constantly monitoring the patient and comfortable with intubating in an emergency situation and trained in resuscitation. For these reasons, we feel that an anesthesiologist or CRNA dedicated to monitoring the patient is a safer option. Could a GI physician do it? Yes. Is it the right thing to do? Most of [anesthesiologists] would say not.
Learn more about Anesthesia Healthcare Partners.
