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age and medical condition, with very low-dose increments you can
change from a moderate sedation to a deep sedation where the cough
and swallowing reflexes are no longer present. Propofol has that proper-
ty about it to tip the balance very quickly. You need a skilled airway per-
son in there delivering it."
In a statement, Yorkville says they do not administer general anes-
thesia, saying they use light to moderate sedation.
"General anesthesia has never been administered at Yorkville
Endoscopy," the statement says. "The type of sedation used at
Yorkville Endoscopy is monitored anesthesia care. Our anesthesiolo-
gists utilize light to moderate sedation."
Dr. Stanfield finds it hard to believe that a competent anesthesiolo-
gist was present during Ms. Rivers's case. "If there was a trained
provider there, I don't see how this could have happened — how the
situation could have progressed to a hypoxic brain injury."
Kenneth Rothfield, MD, MBA, chairman of the department of anes-
thesiology at Saint Agnes Hospital in Baltimore, Md., is wary of the
assertion that gastroenterologists or other non-anesthesia providers
can learn to confidently administer propofol. "Propofol is a very
unforgiving drug," he says. "When patients stop breathing, their life is
hanging by a thread and they're depending on the provider to do the
right things. I don't believe other providers have the same skills that
trained anesthesia providers have. For me to feel comfortable, they'd
have to prove to me that they have all the required skills, know-how
and experience to rescue a patient from severe respiratory depres-
sion."
Reputation of surgery clinics
Many bristle at the knee-jerk reaction that surgery centers are not as
safe as hospitals. The statistics show that deaths at ASCs are exceed-
C O V E R S T O R Y
