Anesthetic Agent Diprivan and the American Association of Nurse Anesthetists statement

For Immediate Release
July 9, 2009

Turning a Harsh Spotlight on Propofol Misuse 
Dangerous drug linked to Michael Jackson sparks concern over abuse potential and non-anesthesia professionals providing to patients 

How unfortunate that it took the tragic death of a famous celebrity to sound the alarm on propofol, a potentially dangerous anesthetic drug that can turn deadly when used for the wrong purpose or administered by anyone other than a qualified anesthesia professional.

Used as intended—for surgical or diagnostic procedures conducted in an appropriate healthcare setting by a qualified anesthesia professional such as a Certified Registered Nurse Anesthetist (CRNA) or physician anesthesiologist—propofol is fast-acting, short-lived, and very safe. But when used for other purposes, in other settings, by anyone other than a CRNA or anesthesiologist, the risks can be significant. Unfortunately, until now regulatory agencies, insurance companies, and various non-anesthesia professionals have downplayed the dangers of propofol, virtually treating its use as “so easy, anyone can do it!” It is far from that.

The American Association of Nurse Anesthetists (AANA), representing 40,000 members who deliver more than 30 million anesthetics to patients each year, has taken a strong stance on the dangers of propofol misuse. Through extensive lobbying, testimony, and education, the AANA has continually emphasized two main concerns.

First, propofol can be very addictive. Abuse of the drug is becoming more common among anesthesia professionals and other healthcare providers who have easy access to it. To help address this growing concern, on June 22—just days before the media exploded with reports linking alleged propofol use to pop star Michael Jackson—the AANA became the first anesthesia professional association to publish a position statement, recommending that healthcare facilities keep propofol in a secure environment to reduce the risk of its diversion and abuse by providers. Patients, however, should not needlessly worry about becoming addicted after receiving propofol for a surgical or diagnostic procedure. The risk of this happening is the same as with any other anesthesia/sedation drug received for these purposes—miniscule.  Patients who have questions or concerns about their anesthesia care should never hesitate to ask their anesthesia professional during their preoperative consultation.

Second, the package insert for propofol, which is approved by the U.S. Food and Drug Administration (FDA), requires that the drug be administered by healthcare professionals trained in the administration of general anesthesia—in other words, CRNAs and anesthesiologists. Despite the fact that a patient sedated with propofol can slip into general anesthesia and stop breathing, this potentially dangerous drug which has no antidote is administered in many outpatient facilities by healthcare providers other than CRNAs or anesthesiologists, particularly for colonoscopies and related procedures. Even though mishaps  are rare, would you want a loved one to be sedated with this powerful drug by  someone who is not trained to recognize all the signs and symptoms of general anesthesia, and who is not an expert in patient rescue in the event of drug overdose and emergency?

So why then is this allowed to happen? One big reason should come as no surprise: Insurance companies are not reimbursing for propofol delivery by anesthesia professionals for diagnostic procedures such as colonoscopies because it is considered to be too expensive. Patient safety and comfort, which should be the real drivers of healthcare practice, once again are merely an afterthought.

The AANA and the American Society of Anesthesiologists feel so strongly about this risky business that the two organizations published a joint statement (http://www.aana.com/jointstmt_propofol.aspx) in 2004 stating that whenever propofol is used for sedation/anesthesia, it should be administered only by persons trained in the administration of general anesthesia and who are not simultaneously involved in the surgical or diagnostic procedure. The statement adds emphatically that “failure to follow these recommendations could put patients at increased risk of significant injury or death.” Consistent with the joint statement, on May 28, 2009, the AANA testified at an FDA hearing that propofol administered by healthcare providers who are not expert in general anesthesia, resuscitation, and the use of emergency equipment is highly dangerous.

The bottom line is that propofol is not a sleep aid, is not for recreational use, and is potentially addictive and dangerous in the wrong hands. While the reason for the sudden interest in propofol is indeed sad, we can only hope that the long-overdue attention now being paid to this drug will lead to heightened awareness of its high abuse potential and an increased adherence to the FDA requirement that it be administered only by those qualified to do so.

http://www.aana.com/News.aspx?ucNavMenu_TSMenuTargetID=62&ucNavMenu_TSMenuTargetType=4&ucNavMenu_TSMenuID=6&id=22278

Comments

[latonia]

Thank you for your comment. We don't give legal advice on this blog. You are in California. Check your State Nursing Board opinions related to propofol, State Nurse Practice Act and Regulations, and the American Association of Nurse Anesthetists AANA) website related to the guidelines for administration. You can also contact the Practice Department at the California Nurses Association.

[Anabela Bettencourt]

oh, by the way I practice in CA.

[Anabela Bettencourt]

Can an LVN/LPN recover a Propofol patient in an endoscopy center setting? There is always an RN present.