Nurse-Administered Propofol Sedation Safety Further Confirmed – but Can We Really Allow Our Patients to Drive Afterwards?

present in 97.5% 30 min after the procedure. Patient satisfaction was also very good with 99.8% willing to repeat the same procedure. These findings serve to further confirm the strong impression that propofol is safe for use as a conscious sedation agent for endoscopy in the hands of appropriately trained endoscopists and endoscopy nurses. There are several studies over the last few years (involving over 200,000 patients) examining propofol administration for endoscopy by gastroenterologists and specially trained endoscopy nurses [3–9] . A recent metaanalysis found no increase in the risk of cardio-pulmonary complications with the use of propofol sedation for endoscopy, as compared to the use of traditional sedative agents. There was not a single patient in these studies who required intubation or died. Nonetheless, despite the plethora of safety data relating to the use of propofol by endoscopists and endoscopy nurses, there are still concerns within the community. A key factor is appropriate patient selection as there is a more recent study which reported a very small number of deaths in patients who received propofol for conscious sedation, most of whom were undergoing more prolonged procedures and/or were higher risk ASA (American Society of Anesthesiologists) class [10] . Of note, none of the patients in this recent series underwent colonoscopy or standard routine gastroscopy. The current study by Horiuchi et al. [2] focuses on lowdose propofol in diagnostic EGD, and irrefutably confirms the safety of such a practice. Many of us are familiar with the situation in which a patient is somewhat combative during an endoscopic procedure, but sleeps like a baby for what seems an age afterwards. Despite undoubted advances in this area, it is glaringly obvious that we have significant room for improvement in how we sedate patients. So, what about propofol? Propofol is an intravenous anesthetic agent often used with other agents for delivery of general anesthesia, but increasingly used in lower doses to induce conscious sedation. Hardly a month goes by without some study supporting the use of propofol by non-anesthesiologists for conscious sedation. Propofol has some undoubted advantages over benzodiazepines and opiates [1] . A particular advantage that is much cited by advocates of using propofol for conscious sedation is that it has a very short half-life, between 2 and 4 min, so there is a much shorter time to recovery from the drug than with midazolam, which has a 30-minute half-life. Rapid induction of sedation and subsequent patient recovery would accelerate patient turnover, allowing more procedures to be done per session. Would this be achieved at the expense of safety? It would appear not. In this issue of Digestion , Horiuchi et al. [2] from Japan prospectively look at the safety of nurse-administered low-dose propofol (30–80 mg total) for diagnostic esophagogastroduodenoscopy (EGD). An impressive 12,031 patients were studied. Only 1.1% of subjects developed transient oxygen desaturation, and full recovery was Published online: December 18, 2008