GI procedures have increased across the country and as a direct result so has the use of propofol during those cases. And just as we have seen a sharp rise in these cases, so has a contentious debate on who should administer the anesthetic in the GI suite.
Anesthesia providers contend that a powerful anesthetic such as propofol should be administered exclusively by a trained anesthesia professional while others, namely those involved in a GI practice, see no change in patient safety and outcomes when a non-anesthesiologist administers the drug.
If the regulation that would allow a non-anesthesiologist to administer the drug passes, it could spell the end of the anesthesia provider in the GI suite. The Food and Drug Administration (FDA) recently granted premarket approval for a machine that allows gastroenterologists and nurses to administer anesthesia without an anesthesia provider on-site. The Sedasys System allows GI doctors to administer the anesthetic intravenously to healthy patients undergoing routine endoscopies and colonoscopies while also providing vital patient monitoring factors.
While the manufacturer of the system, Ethicon, does recommend that facilities that use Sedasys retain an anesthesia professional as a standby consultant, it also maintains that it will reduce oversedation and increase physician satisfaction, two areas that are often correlated to the anesthesia provider’s involvement.
Some are not too optimistic that the system is the wave of the future.
“The devil is in the details and depending on the criteria they mandate for someone in the office to have respiratory resuscitative skill sets, coupled with the cost of the machine, it could become unattractive for facilities,” says Jeanette Brown, Somnia’s national director of ambulatory anesthesia. “In my opinion, it will take a while to catch on, and by that point, payers will have already cut back all around on their reimbursement.”