Our goal is to provide you with personalized, safe and effective procedural sedation. We encourage you to discuss any questions you may have regarding your sedation options with our staff and your gastroenterologist prior to your procedure. We have extensive experience with endoscopist-directed propofol sedation, which we use for more than 99% of the procedures we perform at the Southwest Endoscopy Center.
Please be aware that endoscopic sedation practices are rapidly evolving and vary considerably from region to region around the world and within the United States. While we invite guests to this website who are not our patients to learn from the information we are providing here, we recommend that you confer directly with your own gastroenterologist regarding the sedation options that will be available to you for your procedure. The sedation options we offer at Digestive Health's facilities may not be available to you at other practices.
Endoscopist-directed propofol sedation consists of the intravenous administration of individualized doses of a single sedative-hypnotic agent (propofol) under the continuous direction of the gastroenterologist by a trained registered nurse. In our facility, a small dose of midazolam is usually given just before beginning propofol administration. Propofol is a rapid and short acting agent that came into widespread use by anesthesiologists for induction of general anesthesia in the late 1980’s. In recent years propofol has been adapted to the endoscopy laboratory, where it is being used increasingly under the direction of gastroenterologists to induce the levels of moderate-deep sedation typically needed for the comfortable and effective performance of endoscopic procedures. Over 9,000 procedures have been performed using endoscopist-directed propofol at our center, where we have over 3 and a half years of experience with this technique. We also use endoscopist-directed propofol as our primary sedation technique for endoscopic procedures we perform at Mercy Regional Medical Center.
The principle advantages of propofol sedation compared to traditional sedation include: -Very rapid onset of action, allowing accurate personalized dose adjustments as needed to maintain your comfort during the procedure -Very rapid recovery, without lingering amnesia or a sense of being drugged persisting after the procedure -Nausea during recovery nearly never occurs -Higher patient and physician satisfaction with the quality of sedation -Superior patient safety -No increased patient costs or anesthesia fees
Safety
Propofol sedation is safer than traditional endoscopic sedation when administered by gastroenterologists and nurses who have undergone specific training in its use and who follow propofol-specific sedation protocols. As with any sedative, a small risk of allergic or cardiopulmonary complications exists, even with proper use by experts.
As new medical techniques are introduced, controversy over their use is common. The FDA labeling for propofol, which reflects its historic use in anesthesia, states that it "should be administered only by persons trained in the administration of general anesthesia and not involved in the conduct of the surgical/diagnostic procedure." It is common in medical practice for new uses of a medication to evolve based on research reported in the scientific literature. FDA labeling often lags many years behind such advances, and often a drug's labeling is never updated to reflect current standards of care. In this case the labeling has not been updated to reflect the extensive published evidence of safety and efficacy for gastroenterologist-directed propofol sedation. This means that our use of propofol is "off label." Physicians are permitted to use medication off-label, and off-label drug and device use is a common and necessary part of good medical practice. In 2005 the American College of Gastroenterology filed a petition with the FDA requesting modification of its propofol labeling, which still awaits FDA action.
While anesthesiology professional organizations object to the use of propofol except by anesthesia specialists, the American Gastroenterological Association, American College of Gastroenterology and American Society for Gastrointestinal Endoscopy all support this technique in the manner in which it is utilized at our facility. Our protocols were implemented with local anesthesiology guidance and support. On the basis of their training and experience, our doctors independently supervise the administration of propofol at both Mercy Regional Medical Center and at the Southwest Endoscopy Center.
We participate in an international multi-center project reporting on the safety of endoscopist-directed propofol sedation. An initial abstract was presented at the plenary session of the American Society for Gastrointestinal Endoscopy's annual meeting at Digestive Disease Week 2008 in May. Our safety experience in 646,080 cases was published in the October 2009 issue of the journal Gastroenterology.
Watch our lead author, Dr. Doug Rex, Director of Endoscopy at Indiana University Hospital, discuss this research.
Our expertise and leadership in the area of endoscopic sedation is reflected our recent invitation to teach endoscopist-directed propofol sedation at Sedation Competencies for the Endoscopy Team, a course jointly sponsored by the American Gastroenterological Association and the Society of Gastroenterology Nurses and Associates, that was held in Las Vegas, NV in January 2010.
Cost
The cost of sedation is included in Digestive Health’s professional charge and Southwest Endoscopy’s facility fee. There are no additional facility or physician charges for propofol sedation administered under the gastroenterologist’s supervision at the Southwest Endoscopy Center. Mercy Regional Medical Center's charges reflect all pharmaceuticals utilized during a procedure on an itemized basis.
Both upper endoscopy and colonoscopy can be undertaken without sedation when a patient is highly motivated to do this, and is willing to bear temporary discomfort, which in some cases can be significant. Our experience is that most of our patients have a strong preference to experience as painless a procedure as possible. If you have a preference regarding your sedation it is important to convey your feelings about this to the gastroenterologist who will be performing your case and who can fully discuss the management options which may best meet your needs. In many cases, unsedated endoscopy can be provided to patients requesting it. When we plan an unsedated procedure we usually start the exam with sedation-level monitoring and staffing in place, allowing us to immediately sedate you and continue the examination using sedation if unsedated endoscopy is not tolerable for you.
Anesthesiologist services: Monitored Anesthesia Care and General Anesthesia Offered at Mercy Regional Medical Center
In some cases, based on the medical complexity of your history, physical characteristics suggesting an increased risk for complications related to sedation, or the anticipated complexity of the planned procedure, your gastroenterologist may recommend that an anesthesiologist provide sedation-anesthesia services. You may also request sedation by an anesthesiologist as an alternative to having the gastroenterologist direct your sedation. Anesthesia services are available to our patients undergoing endoscopic procedures at Mercy Regional Medical Center. Anesthesia services are professional services rendered by physicians who are highly trained and experienced specialists in the field of anesthesiology and are not directly affiliated with Digestive Health. Charges for anesthesia services are separate from and in addition to professional charges for endoscopy services rendered by Digestive Health's physicians. These charges are generally covered by health insurance policy in accordance with your insurance contract, though some carriers may only provide for anesthesia services for endoscopy in special medical situations.
Additional Information You may read detailed professional-level information about endoscopic sedation at SedationFacts, a project of the American Society for Gastrointestinal Endoscopy, American Gastroenterological Association, American College of Gastroenterology, American College of Gastroenterology and Society of Gastroenterology Nurses and Associates.
The material provided on this website is for general informational purposes only. If you need specific medical advice, please contact our office for an appointment.
