Conscious Sedation Consulting announces the development of a course to educate
non-anesthesia physicians and nurses in the administration of propofol. The
company announced that a comprehensive didactic course will be provided
nationally for physicians, staff and organizations which wish to add propofol
administration to their choice of sedatives. The course covers patient
selection, a comprehensive detailed explanation of the pharmacology and
pharmacokinetics of propofol, BIS monitoring, computer-controlled infusions,
airway management, physiological monitoring, as well as the prevention,
recognition and management of adverse events. Also covered are documentation,
accreditation standards, patient recovery, discharge, follow up and process
improvement. The seminar uses as a foundation, an understanding of a culture of
safety as described by the Institute of Medicine in its report To Err is Human.

Propofol (2,6-diisopropyl phenol) is classified as an ultra-short-acting
hypnotic agent that provides sedative, amnesic, and hypnotic effects. Propofol
rapidly crosses the blood-brain barrier and causes a depression in consciousness
that is likely related to potentiation of the g-aminobutyric acid A receptor in
the brain.1 Propofol is 98% plasma-protein bound, and it is metabolized
primarily in the liver by conjugation to its glucuronide and sulfate to produce
water-soluble compounds that are excreted by the kidney. Typically, the time
from injection to the onset of sedation is 30 to 60 seconds. Its duration of
effect is 4 to 8 minutes. The pharmacokinetic properties do not significantly
change in patients with renal failure or moderately severe chronic liver
disease. Dose reduction is required in patients with cardiac dysfunction and in
the elderly as a result of decreased clearance of the drug. Propofol potentiates
the central nervous system effects of analgesics and sedatives such as
benzodiazepines, barbiturates, narcotics, and other hypnotic/sedative agents.
Therefore, the dose requirements of these agents may be reduced. The
cardiovascular effects of propofol include decreases in cardiac output, systemic
vascular resistance, and arterial pressure.2 Negative cardiac inotropy and
respiratory depression can be seen with the use of propofol. These effects
reverse rapidly with dose reduction or interruption of drug infusion3 and rarely
require temporary ventilator support.

Controversy surrounds the use of Propofol by non-anesthesia providers. This is
in part due to the FDA approved package insert which states that propofol should
be administered by individuals trained in the administration of general
anesthesia. Additionally some independent practitioners are either unwilling or
unable to administer propofol due to local institutional policies or in some
cases state regulatory restrictions. In spite of such concerns propofol use has
seen a dramatic increase over the last decade. A 2006 study published by the
American Journal of Gastroenterolgy reported that 68% of US endoscopists using
conventional sedation indicate that they would prefer to administer propofol but
are reluctant to do so because of widespread perception of increased
complication risks.4 Propofol is more widely used in other countries.

John Hexem, MD, PhD, board certified anesthesiologist and co-founder of
Conscious Sedation Consulting, LLC, stated "When used judiciously by physicians
with specific training in the administration of propofol, it is a very nice
drug. It has very favorable pharmacokinetic properties and patients regain full
consciousness quickly, alert and comfortable. I have been administering propofol
since 1991 and think it has definite advantages." Dr. Hexem also cautions that
"proper monitoring and training that includes advanced airway management skills
should be acquired prior to using this drug. Providers using propofol also need
a thorough understanding of the continuum of sedation as described by the
American Society of Anesthesiologists and national accrediting and safety
organizations".

Since 2002 more than 500,000 subjects have received propofol for endoscopic
sedation.5
From this data, propofol in appropriate patients with trained personnel has
demonstrated an excellent safety record. Transient hypoxia occurs in 3% to 7% of
cases and transient hypotension in 4% to 7%. Time to recovery ranged between 14
and 18 minutes. In a retrospective review of Nurse Administered Propofol
Sedation (NAPS) in several centers and involving greater than 36,000
endoscopies, the rate of clinical adverse events, defined as apnea or airway
compromise that required assisted ventilation via bag-mask, ranged from 0.1% to
0.2%. 6 No patients required intubation, and none had permanent injury or death.

For additional information please visit online at www.SedationConsulting.com
Or call at 888.581.4448 888.581.4448 .

About: Conscious Sedation Consulting LLC, a patient safety advocacy firm that
provides continuing education, training and consulting services to non
anesthesia health care providers who offer sedation and analgesia services.

Statement of Disclosure: It is the policy of Conscious Sedation Consulting LLC,
its principles and any of its employees to disclose any financial interest or
other relationship with a commercial interest producing healthcare goods or
services that has a direct bearing on the subject matter of any educational
activity. A relevant financial interest or other relationship may include such
things as grants or research support or a relationship such as an employee,
consultant, major stockholder, member of speaker's bureau, and the like, that
has been established for any dollar amount over the past 12 months. We have
nothing to disclose.

Conscious Sedation Consulting LLC
2016 Clermont Crossing Dr. Suite F
Saint Louis MO. 63146
888.581.4448 888.581.4448
www.SedationConsulting.com


1) Trapani G, Altomare C, Liso G, et al. Propofol in anesthesia: mechanism of
action, structure-activity relationships, and drug delivery. Curr Med Chem
2007;7:249-71.
2) White PF. Propofol pharmacokinetics and pharmacodynamics. Semin Anesth
1988;7:4-20.
3) Short TG, Plummer JL, Chui PT. Hypnotic and anaesthetic interactions between
midazolam, propofol and alfentanil. Br J Anaesth 1992;69: 162-7.
4) Cohen LB, Wecsler JS, Gaetano JN, et al. Endoscopic sedation in the United
States: results from a nationwide survey. Am J Gastroenterol 2006;101:967-74.
5)Cohen LB, Hightower CD, Wood DA, et al. Moderate level sedation during
endoscopy: a prospective study using low-dose propofol, meperidine/fentanyl, and
midazolam. Gastrointest Endosc 2004;59: 795-803.
6) Rex DK, Heuss LT, Walker JA, Qi R. Trained registered nurses/endoscopy teams
can administer propofol safely for endoscopy. Gastroenterology 2005;129:1384-91