2005P-0267 Remove from label for propofol (Diprivan) the warning that propofol should be administered only by trained persons
FDA Comment Number : EC159
Submitter : Dr. Reuben Wechsler Date & Time: 11/17/2005 01:11:41
Organization : Dr. Reuben Wechsler
Category : Health Professional
Issue Areas/Comments
In this era of ever shrinking reimbursement, common sense often gives way to frustration. The GI doctors we work with want us in the room. They know that we provide a superior experience for the patient, in part because we can use propofol, but often chafe at the idea that our reimbursement exceeds theirs. Hence their push to be able to give propofol themselves or to supervise others.
I have a relative who is a Gastroenterologist who at a recent GI society meeting expressed his strong objection to his society wanting to administer propofol. Why? Because the GI doctor's primary concern is the endoscopic procedure, not the airway. An RN administering propofol under a gi doctor's supervision puts the patient at undue risk of losing their airway, because only anesthesia personnel are trained to use general anesthetic agents and deal with the very real possibility of a patient losing their airway and/or entering a general anesthetic state instead of simply being sedated. Incidentally, his opinion was not warmly received.
I understand the GI docs' frustration. But i don't request to perform surgical procedures myself because a surgeon's reimbursement is higher than mine and i think i can do just as good a job. I know better. I don't request priveleges to perform ECT's because the psychiatrists make more on the procedure than I, because I know better.
Propofol is an anesthetic agent. Its use should remain resticted to those professionals who are trained in administering general anesthesia. This is the highest degree of safety, and our patients in these United States deserve no less.