Propofol is an ultra-short-acting sedative agent with no analgesic properties, which, at subhypnotic doses, provides sedative and amnestic effects, according to the release. Currently, its use is advised by the FDA for use by trained anesthesia professionals, but its use has been expanded for use in procedural sedation, warranting the investigation into NAAP.
The four societies listed many benefits for the application of NAAP for GI procedures including an equivalent safety profile to that of “standard sedation,” greater efficacy in certain endoscopic procedures and cost-effectiveness.
The statement also includes the following training guidelines for NAAP for GI endoscopy:
- NAAP requires the acquisition of skills and abilities that are distinct and apart from those necessary for standard sedation. Training programs should provide didactic and practical, hands-on learning experiences.
- Individuals administering propofol should be proficient in the management of upper and lower airway complications, including manual techniques for re-establishing airway patency, use of oral and nasal airway devices, and proper bag-mask ventilation. Basic life support or advanced cardiac life support certification is required. Training with life-size manikins and/or human simulators improves the acquisition of these skills.
- Preceptorship (practical experience and training that is supervised by an expert such as an anesthesiologist or qualified endoscopist) is an important element of training for physicians and nursing personnel acquiring the skills to administer propofol.
- Capnography (a monitoring device that measures the concentration of carbon dioxide in exhaled air and displays a numerical readout and waveform tracing) reduces the occurrence of apnea and hypoxemia during ERCP/EUS and upper endoscopy/colonoscopy.
Read the entire Position statement: nonanesthesiologist administration of propofol for GI endoscopy (pdf).
Read the release about nonanesthesiologist-administered propofol.
