Ask Michael Jackson! OH, that’s right, you can’t, he’s dead because his physician thought he could administer propofol without an anesthesia “standard of care”. There is a reason anesthesia is a specialty! Because we (the anesthesia profession) has made it safer than it has ever been doesn’t mean we should allow anyone who thinks it looks “easy enough” to practice outside of their scope. Who do you want taking out your gallbladder? A general surgeon or an orthopedic surgeon? Bread and butter surgery, no big deal! Looks easy enough.

As Christopher says above,why on earth would you want anyone other than a trained specialist to administer a gneral anaesthetic?

The reason that anaesthesia is as safe as it is comes down to the training and skills developed over a significant amount of time,and the ability to deal with the problems that can occur.

What's going to happen when the "non-anaesthetist" anaesthetises a day-stay patient in a site remote from the main theatres and the patient then vomits and obstructs.......or turns out to be a difficult intubation....or.....etc etc

That's when the patient dies or develops hypoxic brain damage and the lawyers come to visit the hapless "non-anaesthetist".

In short...leave anaesthesia to the professionals,just as we leave surgery to surgical professionals.

An Intensivist uses in ICU / CCU for sedation of patients. But, although it is a very good drug, as we all know it is having serious consequences and adverse effects too. So, administering a general anesthetic without anesthesiologist or by those without proper training should not be allowed.

My experience: I remember that some time I was called to resolve why there had been two cardiac arrests and 6 cases of hyperthermia (up to 40 and 41 ° C) of every 10 operated, in the post-operative of a hospital, it was a mission of surgeons operating continuously up to 25 cases daily, had two anesthetists and the only anesthesia that had brought was the Propofol, reminds me of the case of Michael Jackson and review all the Pharmacology of Propofol, Bingo that was the cause of everything: MALIGNANT HYPERTHERMIA and the Cardiac arrests, To bath all patients and administer Acetaminophen plus Hydration. All was resolved after 6 hours, having been metabolized the Propofol, we explained in English that in the pharmacy of the hospital there were other anesthetics, that they needed a medical translator, not the standart translators that accompanied them and a previous communication to program the More than 200 surgeries that had to be done about what the hospital could provide. I would not recommend for Minor Surgery, which should be used by Anesthesia Specialists who know the Pharmacology and the Quirofano well equipped with everything that provides Safety to the Patient. And for those who go out to do missions, carry two bags of anesthesia separately, in case you miss one at the airport

Mi experiencia: Recuerdo que cierta ocasión fui llamado para resolver el ¿Por que habían ocurrido dos paros cardíacos y 6 casos de hipertermia (de hasta 40 y 41°C) de cada 10 operados?, en el post operatorio de un hospital, era una misión de cirujanos operando continuamente hasta 25 casos diarios, tenían dos anestesistas y el único anestésico que habían traído era el Propofol, me recordé del caso de Michael Jackson y revise Toda la Farmacología del Propofol, Bingo ese era el causante de todo: HIPERTERMIA MALIGNA y los Paros Cardíacos, A bañar a todos los pacientes y administrar acetaminofen más hidratación. Todo se resolvió después de 6 horas, al haber sido metalizado el Propofol, les explicamos en Ingles que en la farmacia del hospital había otros anestésicos, que necesitaban un traductor medico, no los traductores de Ingles standart que les acompañaban.y una comunicación previa a programar las más de 200 cirugías que tenían que realizar acerca de lo que podía proporcionar el hospital. No recomendaría para Cirugía Menor el Propofol, que debe ser usado por Especialistas en Anestesia que conozcan bien la Farmacología y el Quirofano equipado con todo lo que brinde seguridad al Paciente. Y para aquellos que salen a hacer misiones llevar dos maletas de anestésicos por separado, por si se les pierda una en el aeropuerto.

Just another little thought.....I've been around long enough to remember Propofol being introduced and can still remember the results of a drug that looked like a very large ampoule of Diazemuls,and in the eyes of some,was therefore a better thing.

We had several instances of patients being presented unconscious and/or apnoeic for emergency intervention by on-call anaesthetic teams,when the person administering the drug had exceeded their limited skills......

Let's not go back there.

I agree with the statements above - why would you let a non-anaesthetically trained person by which I include intensivists, give a general anaesthetic to a patient? Are the non-trained individuals who are using it for sedation able to manage a patient's airway in the event of apnoea or aspiration, given that the dose for an individual is not necessarily predictable?

most of all answers are correct and appreciated sure.. thanks for all. i think it is risky sure to use propofol out of anesthesia field . the propofol provider must know how to support airway, dosage, propofol pharmacodynamics, monitor vitals, how to manage any side effects or complications.

The point about the provider knowing about dose,pharmacodynamics etc etc applies equally to all drugs being administered,irrespective of type,and underlines the fact that if you are administering a drug,you must know all of the above,and how to deal with the side effects or complications thereof.

The big thing with anaesthetic drugs is that the consequences will be fast and potentially life-threatening when things go wrong.

Don’t do it.

@Alexander Bankov, Well said!

Propofol should only be given by appropriately trained individuals. Aside from a good understanding of the pharmacology of propofol and any co-administered drugs, they should have advanced airway skills and be adept at bag-mask ventilation, use of LMAs, endotracheal intubation and emergency front-of-neck access (e.g. cricothyroidotomy). In most places that is limited to anaesthetists/anesthesiologists, intensivists, emergency physicians and some pre-hospital medical practitioners.

Dear Gill Hood. While I agree fully with your concern, I want to inform you that in our country (India), Intensive care training do consists of training in airway, resuscitation (usually under anaesthesia faculty) as well as sedation and analgesia. Moreover, in our country, majority of the intensivist are from anaesthesia background (specialized in anaesthesia and super specialized in critical acre medicine). But Yes, if an intensivist do not have adequate skill for airway management (which is probably rare), then Propofol should not be used for sedation as equally effective or even better sedatives are there to be used as alternatives.

Propofol Sedation: Who Should Administer?

Problem Using propofol (DIPRIVAN) to sedate patients during endoscopic and other diagnostic procedures is gaining momentum in a growing number of hospitals, outpatient surgery centers, and physician offices.[1] In trained hands, propofol offers many advantages over other drugs used for sedation because it: •Has a rapid onset (about 40 seconds) and a short duration of action •Allows patients to wake up, recover, and return to baseline activities and diet sooner than some other sedation agents •Reduces the need for opioids, thus resulting in less nausea and vomiting.[2] Trained nurses in most critical care settings often administer propofol safely to patients who are intubated and ventilated. However, some practitioners have been lulled into a false sense of security, allowing the drug's good safety profile to influence their beliefs that propofol is safer than it really is. 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? Not enough, as the following events show. Believing that propofol was "used all the time in ICU," a gastroenterologist asked a nurse to prepare "10 mL" (10 mg/mL) 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. Another nurse who was trained in the use of moderate sedation, but not deep sedation or anesthesia, assisted the gastroenterologist. After questioning the physician about the dose (100 mg is a high dose), she began administering the propofol via an infusion pump. The patient suddenly experienced respiratory arrest. Fortunately, ICU staff were able to help with the emergency and quickly intubated and ventilated the patient. Another case involved a physician who thought he could safely administer propofol himself while performing a breast augmentation. Unfortunately, his patient, a young woman, died of hypoxic encephalopathy because he failed to notice the patient's rapidly declining respiratory status, as had his surgical assistant, who was not qualified to monitor patients under deep sedation or anesthesia.[3] Nurses have also been asked to administer "a little more" propofol if the patient moved after the anesthesiologist left the room. In these cases, the anesthesiologist would leave the propofol syringe and needle in the IV port after placing the block and leave the nurses in the room to monitor the patient alone. Initially, the nurses reluctantly complied. Later, they brought the issue to the attention of hospital leaders, citing that they were worried about the safety of this practice.[2] There are several compelling reasons why all healthcare providers should be worried about nurse-administered propofol.

Safe Practice Recommendation ::--

At each organization, an interdisciplinary team, including chair of the anesthesia department, should establish policies and practice guidelines for the administration of propofol (or other induction agents such as thiopental, methohexital, or etomidate) to nonventilated patients undergoing surgical or diagnostic procedures. To best inform your team's decision about this controversial issue, consider the following: Check with your State Board of Nursing to determine if nurse-administered propofol is deemed within the professional nurses' scope of practice. If so, explore the various position statements available on this topic from professional societies, including the: • American Society of Anesthesiologists (ASA) • American Association of Nurse Anesthetists (AANA) • American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF) • American College of Gastroenterology (ACG) • American Gastroenterological Association (AGA) • American Society for Gastrointestinal Endoscopy (ASGE) • Society of Gastroenterology Nurses and Associates (SGNA)

https://www.medscape.com/viewarticle/518218_2

The debate about who should be allowed to administer propofol may continue, but one thing is clear: whenever propofol is used for sedation/anesthesia, it should be administered only by persons who are: (1) trained in the administration of drugs that cause deep sedation and general anesthesia, (2) able to intubate the patient if necessary, and (3) not involved simultaneously in the procedure itself.

my prsentation about the question---

Dear

Ali Saad, Excelent review of your Propofol power point conference (I don´t see malignan hipertermia), I remember The Ketamine (used for GI procedures), with exactly, the same effects post procedures that you describe, Thanks you.

Congrats.

I would not advise the use of propofol by non-anesthetic individuals. The risk is too great.

One near-critical mishap happened recently in our centre while gastroenterologists administering propofol at their own during procedure!

THE APPLICATION OF PROPOFOL WITHOUT ANESTHESIOLOGIST IS RISK AND DANGEROUS BY PATIENTS.

Some years ago, European Society of Gastrointestinal Endoscopy (ESGE), European Society of Gastroenterology and Endoscopy Nurses and Associates (ESGENA) and the European Society of Anaesthesiology (ESA) published a guideline on non-anaesthesiologist administration of propofol for gastrointestinal endoscopy. However, these guidelines were retracted by ESA ( Article Retraction of endorsement: European Society of Gastrointesti...

As a member of the ESA Council at the time and member of Board of Directors of the European Society for Intravenous Anaesthesia, I was highly involved in that discussion; the retraction of ESA endorsement constituted a very important step towards patient safety!!

Propofol should be used only by trained professionals for procedural sedation: anesthesiologists and anesthesia nurses! Look the example of Michael Jackson or Joan Rivers (https://eu.usatoday.com/story/life/2015/09/04/one-year-anniversary-joan-rivers-death-what-happened-doctors-clinic/71649424/). Very interestingly, her physician/endoscopist, Lawrence Cohen, was one of the most known gastroenterologists advocating in the scientific literature the use of propofol by non-anesthesiologists (https://www.ncbi.nlm.nih.gov/pubmed/?term=cohen+l+and+propofol).

Finally, I duo not agree with the doses that you've mentioned in your presentation! Today, we shouldn't talk about average doses but individual doses, I mean no more 1.5 to 2 mg/Kg for loss of consciousness!! Please titrate the individual requirements! We have young, healthy patients who loss consciousness with 50mgs!!!