To the Editor: The report by Dr Liu and colleagues1 on use of anesthesia services for routine endoscopic procedures and the accompanying editorial2 discussed some but not all of the factors driving current trends. For some endoscopists, the issue is not that they want anesthesia services but rather they want to use propofol. However, it is difficult for endoscopists to supervise the administration of propofol by registered nurses without the involvement of anesthesia specialists, despite evidence that it can be done safely and endorsement of the practice by numerous nonanesthesia professional societies.3 One obstacle to the administration of propofol by endoscopists is the propofol package insert and the FDA,3 which requires administration only by trained anesthesiologists, thus creating medical-legal risk for nonanesthesiologists who use propofol.
Rex DK. Anesthesia Care for Low-Risk Patients Undergoing Gastrointestinal Endoscopies. JAMA. 2012;307(24):2585–2587. doi:10.1001/jama.2012.6535
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