Response From the Authors

We certainly appreciate your letter to the editor, which helps clarify a complicated issue and gives the readers important information that we had not covered. You showed how to safely implement change within your practice, which included contacting your State Board of Nursing (BON) to clarify its guidelines for nurse-administered propofol. This is a dynamic, evolving issue, and it was helpful to hear how you dealt with it.

Your position is correct in that while the Texas BON does not absolutely prohibit the use of propofol in nonintubated patients, there are few exceptions to the rule. Not all gastroenterology facilities have the resources and expertise that your center has to provide this level of service safely. As the BON points out in their position statement, even ACLS training/certification does not ensure "that the RN or non-CRNA advanced practice registered nurse has the knowledge, skills, and abilities to rescue a patient from deep sedation or general anesthesia." Interested readers should review the full text of the Texas BON position statement at http://www.bon.state.tx.us/practice/position.html#15.8.

The advantage of propofol over some of the other drugs is its very short half-life, so conceivably only a short time of rescue breathing should ever be needed. As the singer Michael Jackson's recent death illustrates, however, propofol must always be given by someone with the training and experience needed to rescue patients if complications do occur.

Respectfully,

Kathy Daniel, PhD, RN

Marilee Schmelzer, PhD, RN