Should non-anesthetists be using propofol?

[Therese Huntly]

Our hospital is currently doing an audit and practice review of sedation in outlying areas being given by non-anesthetists. The three main areas of concern are the radiology unit where nurses are giving midazolam, fentanyl and propofol, the gastro suite (same) and the emergency room. It is the last case that is especially worrying - I have sometimes wandered past to see a comatose young man lying on a trolley with little or no monitoring, obstructed airway and nobody around. When I asked the nurse what this patient's situation was, they replied it's OK, he had a dislocated ankle and the doctors gave his propofol to reduce it. Looking at his notes, the patient's fasting time was just one hour. His level of sedation now (that he was out of pain) was such that it would cause concern in any O.R. recovery unit. Yet here, untrained (?junior) doctors are giving essentially GA's with extremely poor monitoring and safety standards, and in NON_FASTED patients.

Should non-anesthetists be using propofol?  My aswer is no.

[jbrad]

My learned college (ANZCA) has a joint professional document with the dentists which gives its imprimatur to dentists with a diploma in sedation to sedate (with whatever drugs they like- in practice at least Propofol, Midaz, alfentanil) while they themselves do the dental work. In their isolated practices! Propofol in the emergency dept sounds safe compared with that.

[yogenbhatt1]

Was called by a fellow anaesthesiologist recently to resuscitate a pt of Medazolam induced resp depression. On reaching we found that patient was better after the hospital staff ventillated the pt with Ambu bag for a while. But still unconscious and deep. The gynaecologist thought he can perform a D & C without an anaesthesiologist, under mild sedation. He gave Medazolam 2 mg( 2ml). and the pt went in resp failure, as shown by the SpO2 monitor.
They later found that it was not Medaz but Succinyle choline of some companey with an exactly simillar lable. Patient was lucky, and after a brief stay ( 48 hrs) in ICU with venti support, recovered and went home. As humans even we can make an error. So it is better, they do not fiddle with our drugs. Our drugs are lethal in pharmacological doses, if one does not know how to use them.

[frontier]

hi,
  i think not a single anaesthetic drug either midazolam,propofol or ketamine or anything else shouldn't be allowed to be used by non-anaesthesist.it should be strictly followed .in case of any catastrophe only an anaesthesiologist is going to manage the situation.To give sedation in MRI or CT scan room even more difficult due to lack of resususcitative eqipments normally.regards

[jafo1964]

The boundaries of various specialities is getting blurred with a lot of overlap. In the future we will have no options but to accept this scenario.
Imagine a non-anaesthetist Casualty or Emergency medical officer requiring to control a status epilepticus or gain urgent airway in a trauma patient who is unco-operative. He might have to use sedatives, IV anaesthetics and relaxants in this patient. There is no rule that says only anaesthetists can intubate trachea.
On the flip side we are starting to use ultrasound for nerve blocks and CVC. TEE is also an adaptation of radiological devices. Imagine the radiologists claiming, since it is their area of expertise, only they can do blocks.
The list is endless
BIS monitor encroaches on EEG technicians job
CT surgeons may claim that IABP is their prerogative
Orthopods may want to do all intra-osseous routes
Chest people will lay claims over FOB use
and finally ENT surgeons way want to intubate

So I think we must be mentally prepared to accept this change
All we need to ensure is safety of the patient.
So just being an anesthetist, need not necessarily make you a safe person. If it were so, there would be no anaesthesia related casualities...........
........inadequately educated and trained people exist in all specialities including anaes.
lets educate all of them for the safety of the patient