Gastroenterologists and registered nurses can safely administer propofol during GI endoscopies, as long as they receive specialized training before delivering the sedative, say 4 professional organizations in a joint recommendation issued last week.

A position statement by representatives of the American College of Gastroenterology, the American Society for Gastrointestinal Endoscopy, the American Gastroenterological Association Institute and the American Association for the Study of Liver Diseases, argues that "Anesthesiologist-administered sedation for healthy, low-risk patients undergoing routine GI endoscopy results in higher costs with no proven benefit with respect to patient safety or procedural efficacy."

The statement emphasizes, however, that safe administration of propofol by non-anesthesia providers demands a multifaceted education program consisting of hands-on training in upper and lower airway complication management, the use of oral and nasal airway devices, proper bag-mask ventilation and techniques for manually re-establishing airway patency. Non-anesthesia providers must also gain certification in basic life support or advanced cardiac life support and undergo supervised training by an anesthesiologist or qualified endoscopist before working with propofol, according to the statement.

In 2004, the American Association of Nurse Anesthetists and the American Society of Anesthesiologists jointly issued a statement on propofol administration. "Whenever propofol is used for sedation or anesthesia, it should be administered only by persons trained in the administration of general anesthesia, who are not simultaneously involved in these surgical or diagnostic procedures," the statement advises. It noted that the restriction is concordant with specific language in the drug's package insert and that failure to follow these recommendations could put patients at increased risk of significant injury or death.

Jay Horowitz, CRNA, president of Quality Anesthesia Care Corp. in Sarasota, Fla., says he understands why having a nurse, whose services would not generate another bill or additional reimbursable services, deliver propofol would be desirable to some facility administrators. But, he adds, "No nurse or non-anesthesiologist physician will have the thousands of total anesthetic management cases and intubations that make handling airway and hemodynamic emergencies second nature to CRNAs and anesthesiologists."

Daniel Cook

A Pennsylvania man who stole $234,136 from an ASC where he worked as the business manager was sentenced to 2 1/2 to 5 years in state prison last month after admitting to a series of thefts.

Joseph Grostas, 35, pleaded guilty to 3 counts of embezzling using a company credit card and electronic transfers to his bank account. Mr. Grostas used money stolen from the Surgery Center at Brinton Lakes in Glen Mills, Pa., to pay bills, purchase a motorcycle, pay his wife's college tuition, dine in restaurants and take friends on a trip to Nashville, Tenn.

Mr. Grostas' attorney, Timothy Possenti, told the court that Mr. Grostas's marriage was falling apart and that he had fallen behind on bills at the time that the thefts occurred, according to a published report. Mr. Grostas, who says he will pay back the money, will serve 16 years of probation following his prison term.

Surgery center administrator Gina Espenschied, RN, BSN, CNOR, who discovered the theft in March while reviewing the financial statements, did not immediately return calls for comment. Her audit revealed that Mr. Grostas had dipped into the facility's funds from March 2008 until his arrest in March 2009, she told Outpatient Surgery Magazine. "He would have knocked us out of business entirely if his stealing went on for much longer," she said at the time.

Kent Steinriede

Medical manufacturer Steris says it disagrees with a safety alert the U.S. Food and Drug Administration issued last week, in which the agency urged users of the Steris System 1 to find an alternative method for sterilizing and disinfecting their instruments.

Besides stating that the modified version of the SS1 has not received FDA approval, the safety alert says that the agency has received reports of operational malfunctions in the popular tabletop liquid chemical reprocessor that could cause such "serious injuries" as patient infections. If you have an acceptable alternative to the SS1, the FDA says, you should transition to that alternative.

Steris responded yesterday by saying that the SS1 is safe and effective when used as directed. "We are working to engage in further dialogue with FDA about this matter," says the company.

Steris notes that there has not been a documented case of infection directly caused by a SS1 when certified health professionals have followed proper guidelines and instructions.

The SS1 was introduced in 1988. More than 23,000 units have been used in more than 5,000 hospitals and clinics in the United States, sterilizing more than 300 million medical devices or about 30,000 per day. Users who have questions or require immediate assistance can contact Steris at (440) 392-7223.

Dan O'Connor

We want to know if your staff is getting a little something extra in their paychecks for the holidays this year. Tell us in this week's InstaPoll. We'll report the results in this space next week.

Last week, we asked if you were concerned that healthcare reform legislation would negatively impact your surgical business. More than three-fourths (78%) of the 66 respopndents were pretty sure that new healthcare laws wouldn't be kind to outpatient surgery.

Dan O'Connor