Author's Response

After a review of the article in question, I have confirmed that the reference was indeed cited correctly. I invite the concerned reader simply to reference the source to substantiate this claim. The reference is the Institute for Safe Medication Practice (ISMP) (2005) Medication Safety Alert entitled "Propofol Sedation: Who Should Administer?" The ISMP is a nonprofit organization that educates clinicians and consumers about safe medication practice. This article also can be retrieved from the Internet at http://www.ismp.org/Newsletters/acutecare/articles/20051103.asp.

In addition, I refer the reader to the American Association of Nurse Anesthetists (AANA) and American Society of Anesthesiologists (ASA) joint statement regarding propofol administration and the package insert for recommendations concerning the administration of the anesthetic in question (AANA, 2004; Bedford Laboratories, 2005). The intent of the article was simply to give the reader a brief review of the anesthetic agent, propofol. I am sorry if it was interpreted as giving a personal opinion that could not be substantiated. A clinician would not, however, need to have catastrophic reports to understand the profound implications of propofol administration by those who are not trained in advanced airway management and general anesthesia.

Propofol produces a dose-dependent depression of ventilation and apnea (Stoelting & Miller, 2000), inhibits the normal protective respiratory reflexes (Morgan, Mikhail, & Murray, 2005), and can result in collapse of the upper airway due to inhibition of the genioglossus muscle and depression of central respiratory output to the upper dilator airway muscles (Eastwood, Platt, Shepherd, Maddison, & Hillman, 2005). This can result in an airway obstruction from collapse of the soft palate and epiglottis (Litman, 2005).

The clinician who administers propofol should be prepared to traverse the continuum of sedation (quite rapidly) through moderate sedation, deep sedation, and general anesthesia. The clinician should be trained to administer medications for deep sedation and general anesthesia (ISMP, 2005), to monitor the patient adequately because the monitoring parameters for deep sedation should approximate those used for general anesthesia (Odom-Forren & Watson, 2005), to intubate the patient should the need arise, and to not be involved in the actual procedure (ISMP, 2005).

Daniel D. Moos, MS, CRNA

References