Most providers agree that propofol has great advantages in ambulatory surgery, but is it legally safe to provide propofol to RNS without a Registered Nurse Anesthesiologist (CRNA)? That's the million-dollar question. The issue has caught the attention of nurses, anesthesiologist nurses, anesthesiologists, state nursing boards, state legislatures and others.
Nurse-administered propofol sedation (NAPS) is common in gastroenteroscopy, ophthalmology, plastic surgery, and dental procedures. In outpatient surgery, there are always time and cost pressures, and nurse administration of propofol is seen as a way to alleviate these issues. In the trained hand, propofol has many advantages over other drugs used for sedation because it:
• Fast onset (about 40 seconds), short action time
• Enables patients to wake up, recover, return to baseline activities, and resume diet more quickly than other sedations
• Reduce the need for opioids, which reduces nausea and vomiting.
In most intensive care Settings, trained nurses routinely and safely administer propofol to intubated and ventilated patients. However, some practitioners have been lulled into a false sense of security, allowing the drug's good safety profile to affect their belief that propofol is safer than it really is. In the hands of untrained people, propofol can be dangerous and even fatal. It is not safe for a physician who is not trained in the use of such medications to administer medication (which can result in deep sedation and/or general anesthesia) to an unventilated patient, even if administered under the direct supervision of the doctor or dentist performing the procedure. After all, how much supervision can a doctor or dentist provide if he or she focuses on the procedure itself?
