Can CRNAs Work Alone?

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At the American College of Gastroenterology Annual Scientific Meeting, AMSURG partner Murtaza Parekh, M.D., presented his recent study that asked the question, “Do CRNAs need on-site M.D. anesthesia supervision for safe propofol sedation in an ambulatory endoscopy center (AEC)?”

Propofol use is increasing in AECs, and recent studies have found that propofol sedation in procedures such as a colonoscopy resulted in a shorter recovery time and higher patient satisfaction. The propofol warning label states that the drug should only be administered by someone trained in the administration of general anesthesia. Parekh said his team at the Raleigh Endoscopy Center felt that they had three options when they decided to use propofol sedation in 2008: an anesthesiologist in every room, a CRNA with anesthesiologist supervision and a CRNA with a gastroenterologist in the room as the supervision.

The study looked at 106,000 ambulatory endoscopy procedures performed with propofol sedation from October 2008 through August 2013. The study focused on two administration protocols: CRNA with anesthesiologist supervision versus CRNA alone, except for the gastroenterologist. There were 70,436 procedures done by a CRNA with anesthesiologist supervision and 36,483 by a CRNA alone. The same propofol sedation protocol was used for all procedures. The data showed no significant difference between CRNA with anesthesiologist supervision and CRNA alone in the frequency of aspiration, desaturation, laryngospasm, cardiac adverse events, perforation and splenic injury.

“In the end, MD supervision did not significantly impact safety outcomes with propofol in our ambulatory endoscopy center. These conclusions correlate [with previous studies] showing that propofol sedation is as safe, if not safer, than conscious sedation,” Parekh said.

To read Parekh’s study abstract, click here and select “President’s Plenary Session 1”.