Abstract
LETTER TO THE EDITOR: I appreciated the comments of Dr. Horn regarding his adoption of anesthesiologist-administered propofol in his practice. Dr. Horn appears to be a seasoned clinician with a long track record of safe endoscopy. His use of propofol is based on the belief that it is the best for his patients. While no one can argue that the data do support an improvement in a number of parameters with propofol, I believe one has a hard argument to make that, compared to gastroenterologist-provided sedation with a narcotic-benzodiazepine combination, these differences warrant administration to all patients by an anesthesiologist. The societal costs of such a strategy are enormous and not sustainable. In addition, a consensus statement from our three GI Societies on conscious sedation will soon appear, which also endorses the very selective use of anesthesiologist-provided propofol. I could ask the anesthesiologist to give propofol for all my patients undergoing endoscopy or maybe train one of our nurses to give it. Why do I not do this? Because I do not believe it is necessary. Like Dr. Horn, I do believe there are patients who require anesthesiologist support because of an inability to adequately sedate due to chronic narcotic use, alcoholism, etc., and I employ their services for these cases. In contrast to Dr. Horn's practice, however, there are a number of physicians in the United States who clearly use anesthesiologists with the principal goal of improving throughput and not necessarily because of a belief that propofol is better. This is the practice I believe is gaming the system.
Published Version
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