Pushing Propofol
5 Arguments Against RN-Administered Propofol

Questions and disagreements about who should — and who shouldn't — administer propofol aren't likely to go away soon, with some still suggesting that RNs should be allowed to administer propofol under the supervision of gastroenterologists. Perhaps it's a good time to review the concerns that have led the FDA and anesthesia providers to strongly reject nurse-administered propofol.

1. When trained anesthesia professionals administer propofol and monitor patients, gastroenterologists can focus on the procedure at hand. Directed propofol administration by RNs would require GI docs to play an even more active role in observing and monitoring patients.
2. Anesthesia professionals deal frequently with adverse reactions to propofol and airway management issues. They're trained to recognize them quickly and can easily handle most negative situations.
3. Extra vigilance is required with propofol, because you can't reverse its effects with Narcan or Romazicon. If an airway management problem occurs, mechanical intervention is needed, whether it's a chin lift or an emergency intubation.
4. RNs and GI docs rarely intubate patients under any circumstances, let alone during emergencies. That lack of experience can result in tragedy in a patient who turns out to be a difficult intubation. While all healthcare professionals can be trained to manage airways, anesthesia professionals have not only received extensive airway management training through formal education, they also deal with it on a daily basis.
5. There are legal issues to consider. If an adverse event leads to a negative outcome, will the physician have overstepped his bounds by asking a nurse to administer a drug and monitor a patient to an extent not truly within the scope of practice? It's a slippery slope and one that could increase liability in the event of a lawsuit.

— Perry Ruspantine, CRNA, APRN