Is propofol safe for non-anesthesiologists? An important issue with the use of propofol by non-anesthesiologists is that unless administration is strictly controlled, patients receiving propofol may transition from moderate sedation under awake sedation conditions to deep sedation or even anesthesia. As we enter an era of more and more interventional endoscopy, many procedures are getting longer and longer. 

Inevitably, some patients who undergo long-term surgery end up being sedated more deeply than expected. Non-anesthesiologists with lucid sedation certifications are not trained in what is known as "monitored anesthesia care" for deep sedation, in which the normal protective reflex is lost. Potential loss of airway control is a particular concern. 

Although propofol is reported to be safe for conscious sedation, it must not be forgotten that it is an anesthetic. Any new guidelines for the use of propofol by non-anesthesiologists will need to ensure strict adherence to dosing protocols and emphasize the importance of airway management expertise.

Further, is it safe for properly trained caregivers to use propofol? A study involving nurse anesthesiologists showed no difference in safety when comparing propofol and midazolam/pethidine.

However, routine use by anesthesiologist nurses will undoubtedly also make propofo-assisted sober sedation expensive. Further research into the reasons for the use of propofol in endoscopy is needed in studies of the delivery of propofol by nurses who are trained in waking sedation.

If propofol is given by a non-anesthesiologist, what is the most appropriate way to monitor the patient's breathing? In Vargo et al., and previous studies, electroencephalograms were used in addition to standard pulse oximeters and blood pressure measurements during endoscopy under awake sedation.