New Hampshire, where I practice, is one of the states where it's not legal for RNs to administer propofol sedation for surgical and diagnostic procedures ("Shades of Sedation: Learning about Moderate Sedation and Analgesia," April 2006). I sat on the New Hampshire Board of Nursing when this issue was discussed. We carefully reviewed many sources and decided that nurse-administered propofol sedation is outside the usual scope of RN practice.

In my opinion, propofol should be administered for procedural sedation only by professionals with advanced training in the administration of general anesthesia and airway management. Propofol is very potent; even in skilled hands, patients can go from mildly sedated to obtunded in the blink of an eye.

Nurse-administered propofol sedation raises various concerns for nurses who practice in states that allow the practice. For example, does the nurse's insurance carrier cover him when he administers anesthetics? Are economics and productivity pressures given more weight than patient safety? Does the patient know that nonanesthesia personnel are administering an anesthetic to him?

I can envision various remedies for these problems, including changes in drug regimen licensure, education, and more. However, while creative solutions are being explored, we must first keep our patients safe. Anesthesia became a specialty for very good reasons. To ignore those historic lessons is to put our patients and professional reputations at risk.

Thom Bloomquist, CRNA, MSN, FAAPM

Bow, N.H.