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Propofol dosing and titration is variable, based on the patient's tolerance to the drug. A patient can go from breathing normally to a full respiratory arrest in seconds, even at low doses, without warning from typical assessment parameters.(2) Financial incentives.

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In untrained hands, propofol can be dangerous, even deadly; administration to a nonventilated patient by a practitioner who is not trained in the use of drugs that can cause deep sedation and general anesthesia is not safe, even if the drug is given under the direct supervision of the physician performing the procedure.(2) After all, how much supervision can the physician provide if he or she is focused on the procedure itself? Believing that propofol was "used all the time in ICU," a gastroenterologist asked a nurse to prepare "10 m L" (10 mg/m L) of the drug for a patient undergoing endoscopy in his room.

The nurse obtained the drug from an automated dispensing cabinet via override before she transcribed the order to the patient's record.

The ACG, AGA, ASGE, and SGNA endorse nurse-administered propofol under the direction of a physician if state regulations allow it, and if the nurse is trained in the use of drugs causing deep sedation and capable of rescuing patients from general anesthesia or severe respiratory depression. Based on patient safety, professional association position statements, and applicable state laws, determine the qualifications of professionals who can administer propofol to nonventilated patients during procedures.

If nurse-administered propofol is acceptable, specify the circumstances and required education and mentorship that must be accomplished beforehand, and competencies that must be evaluated and met periodically (ACLS certification alone is not sufficient (2)). Doctor still on the hook for 'accidental' surgery death.

To best inform your team's decision about this controversial issue, consider the following: Review regulations/position statements.