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As the debate rages on over who should administer propofol sedation for endoscopic procedures, here's a radical proposal: Adopt a 2-tiered system whereby patients at the highest risk would be sedated by CRNAs and anesthesiologists, while lower-risk patients would be sedated by an RN whose sole responsibility is to provide sedation and monitor the patient, under the supervision of the endoscopist. In such a scenario, both the nurse and the supervising physician would have to be trained and competent in rescuing patients from deep sedation and general anesthesia. When you consider the ongoing turf battle, maybe this isn't such a crazy proposal. It keeps patient safety as the central issue in propofol administration.
