Registered nurse-administered propofol sedation for upper endoscopy and colonoscopy: Why? When? How?

Propofol for sedation during gastrointestinal endoscopic procedures has been associated with improved patient satisfaction relative to combinations of meperidine and midazolam. Delivery of propofol by registered nurses has been shown to be more cost-effective than administration by anesthesiologists or nurse anesthetists. Here, the authors review their experience with nurse-administered propofol sedation (NAPS) at their institutions (a hospital endoscopy unit in a tertiary medical center and an ambulatory surgery center). Endoscopic procedures for which NAPS is (or is not) recommended are listed, and a profile of patients for whom NAPS is contraindicated is given. Steps toward the development of programs and acquisition of training in NAPS are recommended; these include determining what state, local, and institutional laws apply to propofol administration; developing a written protocol; and instituting a training program that proceeds from observation to supervised administration to independent administration of propofol, with appropriate monitoring of safety records. Experience with NAPS using bolus titration (dosage, timing, coadministration with other agents) is detailed, and proper patient monitoring is discussed. NAPS is in its infancy, but this method of sedation shows considerable promise for improving patient satisfaction with, and thereby the reputation of, endoscopic procedures.