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tributing to the death of Ms. Rivers.
An anesthesiologist in the room?
It's also believed that propofol played a contributing factor in the
death of Ms. Rivers, thus reigniting the debate about the dangers of
the sedative-hypnotic.
"Propofol is very safe — until it isn't," says Dr. Sinha. "Propofol doesn't
kill people, but its inappropriate administration does. Anybody can admin-
ister propofol, even little machines. But not everybody can recover a
patient from an overdose of propofol. That includes cardiologists, endo-
scopists and ENT surgeons."
Many GI centers today don't employ anesthesia providers, in large
part because most insurers won't pay for an anesthetist to be present
during endoscopy. What's more, GI docs are skilled at giving propofol
to provide perioperative sedation and pain control. Dr. Cohen is a
leading proponent of endoscopist-directed sedation over monitored
anesthesia care, having authored the landmark paper, Endoscopist-
directed Administration of Propofol: A Worldwide Safety
Experience.
"It is very common to have an incredibly busy 15-suite GI center
going all day and there's no anesthesia professional in the facility,"
says Dr. Shapiro. "Many millions of these procedures in all settings are
done without an anesthesiologist present. It's just the way medicine is
practiced in this country."
It's also a violation of the standards of the American Association for
Accreditation of Ambulatory Surgery Facilities (AAAASF), Yorkville's
accrediting body, which requires that either a nurse anesthetist or an
anesthesiologist administer propofol at its facilities. "Those are the rules
of our accreditation standards," says Geoffrey R. Keyes, MD, FACS, pres-
ident of the AAAASF. "Propofol is special. Depending on the patient's
C O V E R S T O R Y
