approved the use of Sedasys in 2013, it has taken a year for the first hospital to accept its use in a clinical setting. Sedasys is a computerized system that administers propofol autonomously without the presence of an anesthesiologist in the room. It was mired in regulatory limbo for years before the FDA, in extraordinary fashion, reversed its own earlier ruling and allowed it to go into the market, thus realizing most GI doctors' propofol fantasies.
The first medical center to embrace Sedasys has turned up in...Seattle, Virginia Mason to be exact. Otto Lin, M.D., the Director of Quality Improvements at Virginia Mason and also a gastroenterologist, proudly states that, "It really allows us to use propofol, which we believe is superior to midazolam and fentanyl, in outpatients without having the added cost of having the anesthesiologist administer the drug."
Quite frankly, unless the anesthesiologists at Virginia Mason are employed by the hospital, Dr. Lin and the other GI's who work there may have trouble finding any anesthesiologist to back them up when, not if, an airway emergency occurs. Any anesthesiologist knows that once he steps into that procedure room, or even if he is within earshot of the impending disaster behind that closed door, the liability for the airway catastrophe instantly shifts to the anesthesiologist and away from the GI doc. Do they expect anesthesiologists to rush into an unknown and unstable situation at any time and just perform an airway resuscitation on a complete stranger out of the charitable goodness of our hearts?
Anesthesia reimbursement for endoscopies have been steadily eroding anyway. Sedasys was approved by the FDA only for ASA 1 or 2 patients. Insurance companies have increasingly denied anesthesia payments for MAC administered to these relatively healthy patients. Therefore it probably isn't going to have a major effect on most anesthesiologists' incomes. Any anesthesiologist whose livelihood depends on giving anesthetics exclusively to ASA 1 or 2 endoscopy patients every single day probably isn't living up to the potential of his hard earned board certification and should probably move on to something more professionally fulfilling in his life.
So let's see what happens now that Sedasys has been unleashed out into the wild. Will the cost savings really justify its exclusion of the potentially life saving presence of a second physician in the room? Will gastroenterologists accept full responsibility for a patient's airway calamity or will they still attempt to push the job to any anesthesiologist that just happens to be walking past the endoscopy suite? Only time, and a few unfortunate complications and possibly deaths, will answer that question.