The science and politics of propofol.

Propofol use for endoscopy is increasing rapidly. Its administration by registered nurses under the supervision of endoscopists has thus far proven safe, but is not realistically feasible in most U.S. endoscopy units. Therefore, propofol in the United States is being administered almost entirely by anesthetists. Transition to anesthetist-delivered sedation for endoscopy is being accompanied by increased costs, which in turn has the potential to adversely affect endoscopic practice. The gastroenterology and anesthesia communities should work together to explore mechanisms to expand propofol use or an alternative for endoscopy in a safe and cost-effective manner.