Sunday, May 30, 2010

There's An AAP For That

Gastroenterologists have been pining for the right to use propofol for their endoscopic cases for years.  At the recent DDW conference in New Orleans, there were multiple talks on gastroenterologist administered propofol (GAP) or nurse administered propofol (NAP) vs. anesthesiologist administered propofol (AAP).  Everyone agrees that propofol (while it's still available) is superior to other forms of sedation for endoscopy.  The friction between the professional societies is over who is the most qualified to give it. 

I found this little gem from the American Gastroenterological Association.  It is a guide from the AGA Institute on how to give propofol sedation.  One of its tables describes how best to monitor a sedated patient.

Notice that the AGA Institude recommends that ECG monitoring is optional while capnography (the measurement of expired carbon dioxide) is not necessary.  Really?

By comparison. guidelines from the American Society of Anesthesiology on respiratory monitoring during endoscopic procedures state, "Monitoring for exhaled carbon dioxide should be considered during endoscopic procedures in which sedation is provided with propofol alone or in combination with opioids and/or benzodiazepines, and especially during these procedures on the upper gastrointestinal tract."

If your are a patient, who would you prefer to watch over you while you are sedated and helpless? Dr. GI, please stick with what you know best and leave the patient and airway monitoring to the doctors who do this every day, your helpful and friendly anesthesiologists.  Case closed.

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