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Propofol (Diprivan) is an ultra short acting drug that is used for sedation and anesthesia. It is associated with a rapid deepening level of sedation to the level of general anesthesia. As such it has primarily been used by the anesthesiologists. However, it has now been increasingly used in conscious sedation for endoscopic procedures. Its fast onset and short duration of action are ideal characteristics for this purpose especially for outpatient endoscopic procedures where a rapid recovery from sedation is desirable.Propofol (2,6-diisopropylphenol) is a substituted alkyl phenol derivative that is thought to facilitate gamma-aminobutyric acid activity in the brain. Its onset of action is almost instantaneous with a peak effect seen from 90-100 seconds because of high lipid solubility. It also has a short half-life of only 2 to 4 minutes and is rapidly metabolized in the liver as well as re-distributed away from its site of action (i.e., the brain). Propofol also can produce deep sedation, resulting in respiratory depression and even apnea. Furthermore, there is no known antagonist for propofol. For these reasons, the administration of propofol had been originally restricted primarily to anesthesiologists. Increasingly, however, propofol has been administered by endoscopists and nurses - what is called non-anesthesiologist administered propofol (NAAP). NAAP has been shown to be both equally effective and safe compared to traditional sedation of benzodiazepines and narcotic analgesics. Patients' post-procedure satisfaction with propofol sedation appears to be higher compared to traditional sedation. The overall procedure and recovery time is much shorter- a shorter onset of sedation and a shorter time to recovery. Propofol sedation is thought to improve the quality of endoscopic examination although there have been no cost-effectiveness studies comparing propofol sedation versus traditional sedation.Propofol does not provide analgesia. As such, narcotic analgesics are sometimes co-prescribed. In addition, benzodiazepines are also sometimes co-prescribed to reduce the amount of propofol needed. Combined use with traditional sedative agents is termed "balanced propofol sedation".Because of its rapidity in causing very deep sedation with hypoxemia and hypotension, users of propofol sedation must be appropriately and adequately evaluated. Resuscitation equipment must be readily available. Many countries recommend a formal training for NAAP which requires a course in ACLS, simulator training and supervision under people who already have adequate experience with NAAP. |
