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Faced with growing demand for GI endoscopy procedures, declining reimbursements under Medicare's new ASC payment schedule and a shortage of anesthesia providers, GI facilities are looking for ways to maximize the benefits of propofol as a sedating agent (quicker induction and recovery times) while minimizing its biggest negative — the need for direct monitoring by someone trained in the administration of general anesthesia. Patient-controlled sedation with a cocktail of propofol and remifentanil appears to be a promising alternative to anesthesiologist-controlled propofol sedation and could introduce more flexibility to the anesthesia model for GI endoscopy.
