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June 27, 2012

Anesthesia Care for Low-Risk Patients Undergoing Gastrointestinal Endoscopies

Author Affiliations

Author Affiliation: Department of Anesthesiology and Critical Care, Sheba Medical Center, Tel Aviv, Israel (perelao@shani.net).

JAMA. 2012;307(24):2585-2587. doi:10.1001/jama.2012.6537

To the Editor: Authors from the RAND Corporation recently reported that utilization of anesthesia services during gastroenterology procedures increased substantially and that much of the associated expenditure can be considered potentially discretionary because sedation of low-risk patients by nonanesthesiologists is safe.1 The authors partly attribute this seemingly unjustified growth of anesthesia services to the adoption of propofol.1 Due to its short-acting properties, propofol has become a popular drug for procedural sedation. However, propofol administration may be associated with serious adverse effects, which include hypotension, bradycardia, airway obstruction, hypoventilation, hypoxemia, and apnea. In addition, propofol has a narrow therapeutic range, which may lead to an unintentional slip into a state of general anesthesia, especially in elderly patients. When such adverse effects occur, they require active respiratory and cardiovascular rescue measures because there are no specific antagonists that reverse the action of propofol. Because of these well-known risks, the manufacturers of the drug restricted its use to persons trained in the administration of general anesthesia only.