The American College of Gastroenterology raised more than a few eyebrows when it petitioned the FDA to remove the warning from the labeling for propofol, the one that says that only those trained in the administration of general anesthesia and not involved in the conduct of the procedure should handle the drug.

Here's hoping that the FDA just says no.

And fast.

Deleting this warning would make it OK for endoscopists and gastroenterologists and RNs working under their supervision to push propofol.

And that's not OK.

Not because GI docs or nurses are incapable of administering the drug whose only reversal agent is time, but because they could never do so with the required level of safety.

Besides telling us who should handle the drug (anesthesiologists and CRNAs), the labeling for propofol tells us that patients sedated with propofol must be monitored continuously while the drug is being used. We can't see how a GI doc maneuvering a scope and watching a monitor, or a nurse doing this-that-and-the-other-thing in an endo suite, could continuously monitor a patient unless, like your fifth-grade teacher, they grew eyes in the backs of their heads.

RNs have told us that there are much harder drugs to give than propofol, the unpredictably potent sedative that can switch from moderate sedation to deep sedation without notice or permission. But nurses aren't given, or don't take, the authority to be uninterrupted when caring for a patient who needs absolute constant monitoring, says Margaret Plummer, RN, BA, BSN, CCRN, of Astor, Fla., practicing in one of the states whose nursing board has ruled it illegal for RNs to bolus propofol.

"Can you imagine a surgeon asking an anesthesiologist to go find him a pen? But a nurse will get interrupted for everything from phone calls to another patient wanting a cup of coffee," says Ms. Plummer.

The debate over who can use propofol should start and stop with patient safety. To their credit, the GI docs carefully lined their petition with study after study that found that non-anesthesia personnel can administer propofol safely. But then it takes an odd turn, driving home the peg it ultimately hangs its petition on, by crying poor.

Requiring the presence of an anesthesia provider to administer propofol "substantially increases the cost of an endoscopic procedure," reads the plea. Further, "it is inefficient and unnecessary for the cost of an endoscopic procedure to include fees for both a gastroenterologist and either an anesthesiologist or a nurse anesthetist."

Once more, with feeling: Just say no, FDA.