Propofol has many advantages as a sedative and anesthetic over other agents. It has a very rapid onset and an equally quick recovery time. Once the procedure is over, patients can almost immediately return to their regular activities with no down time to recover from the anesthetic. Unlike opioids, it does not cause nausea or vomiting. It is also thought by some to be extremely safe-so safe that anyone can administer it without special training.
The belief that propofol is safe and can be administered by anyone has led to some serious adverse events. If used incorrectly by personnel not specially trained in anesthesia, propofol can lead to respiratory arrest and even death.
For example, a young woman died in 2004 from respiratory arrest due to propofol during a breast surgery that was conducted by a doctor and an assistant without the presence of anesthesia physicians. Neither of the surgeons had ever been trained in deep sedation or anesthesia, and they simply assumed propofol was very safe. Since both surgeons were involved in the surgical procedure, no one was monitoring the patient’s vital signs and her distress wasn’t noticed until it was too late.
No Reversal Agent
Patients often exhibit idiosyncratic reactions to various doses of propofol, and it has to be individually titrated in accordance with the patient’s response to the dose. When patients do go into respiratory distress, often there are few warning signs and the patient seems to just suddenly stop breathing. This means that someone needs to be carefully watching the patient during the entire procedure.
Individuals who are performing other tasks, such as surgery or endoscopy, cannot devote their full attention to monitoring the patient’s vital signs. Another safety problem with propofol is that unlike most sedative agents, there is no reversal agent. If a patient does go into respiratory arrest, the patient can only be treated by supportive life-saving therapy until the drug is metabolized.
For these reasons, most medical organizations strongly recommend that when using propofol for moderate or deep sedation, a specially trained anesthesiologist from an anesthesia medical group like Medical Anesthesia Consultants in Northern California whose job is solely to sedate and monitor the patient, should be the only one administering the drug.
Propofol sedation: Who should administer?, www.ismp.org