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Who can administer Diprivan?

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JCole View Drop Down
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Joined: 03 Oct 2007
Location: United States
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Posts: 128
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    Posted: 04 Jul 2009 at 3:48pm
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STATEMENT ON USE OF PROPOFOL BY NON-ANESTHESIA PERSONNEL

Due to recent movements by some non-anesthesia physician specialties (i.e. gastroenterology, emergency medicine, pediatrics, etc.) to allow the use of propofol for deep sedation during surgical/diagnostic procedures, the ASA supports the position that anesthetic agents, such as propofol, should be administered only by trained anesthesia personnel, under the supervision of a qualified anesthesiologist.

At the present time, the package insert for propofol (Diprivan®) states: “For general anesthesia or monitored anesthesia care (MAC) sedation, DIPRIVAN injectable Emulsion should be administered only by persons trained in the administration of general anesthesia and not involved in the conduct of the surgical / diagnostic procedure.”

The ASA supports the two basic implications of this statement:
  •  propofol should only be administered by those practitioners trained in the administration of general anesthesia, and;
  • those persons shall not be directly and concurrently engaged in the conduct of the surgical/diagnostic procedure so that their full vigilance can be devoted to the state of the sedated patient.

These two statements support the well-established principle that during any surgical/diagnostic procedure there be an independent practitioner whose sole is the administration of propofol and proper monitoring of the patient to assess the level of consciousness and to identify early signs of cardiovascular or respiratory compromise. The corollary benefit of this practice is that the practitioner performing the procedure is free to devote his/her full attention to the procedure, thereby improving patient safety.

Propofol is a powerful anesthetic agent, whose administration carries with it all the associated risks of general anesthesia. Individual patient reactions to such a pharmaceutical agent can be varied and extremely unpredictable. Because the level of anesthetic depth can unintentionally change rapidly during administration of propofol, the clinician administering such agents must be able to recognize and rescue a patient experiencing any number of complications associated with general anesthesia. Moreover, propofol differs from other agents utilized during conscious sedation (i.e. benzodiazepines and narcotics) in that propofol does not have a direct antagonist or reversal medication.

Simply, it is in the best interests of the patients to limit the use of such an anesthetic agent to anesthesia practitioners who are trained not only to administer this drug, but recognize, diagnose, and appropriately respond to its unintended effects. Anesthesia practitioners, be they anesthesiologists, anesthesia residents in training, anesthesiologist assistants (AAs), or certified registered nurse anesthetists (CRNAs), have the clinical knowledge Adopted January 17th, 2006 and technical skills necessary to respond to adverse respiratory or cardiovascular events resulting from administration of propofol.


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Edited by admin - 28 Apr 2013 at 8:41pm
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