Initially plagued by inaccuracies, the technology of CO2-graphy has improved, making it a sensitive tool for detecting hypoventilation and respiratory depression. This is especially important when using propofol, as there are no antagonists available. If respiratory depression is severe, discontinuation of infusion usually results in rapid recovery, but bag and mask ventilation, or even tracheal intubation, may sometimes be required.

For the purposes of discussion, if we agree that non-anesthesiologists can safely use propofol for sober sedation, then the issue of cost-effectiveness needs to be considered. In the current study by Vargo et al., propofol was administered by a gastroenterologist at an additional cost of $403 per patient.

This is not only a huge cost burden, but also an inefficient use of the time of a trained gastroenterologist. Stipulating that propofol should only be administered by trained gastroenterologists who cannot attend endoscopies will have a significant negative impact on the number of surgeries performed. Rapid induction of sedation and accelerated patient recovery time do not adequately compensate for these losses. However, according to a model cost analysis performed by Vargo et al., the cost of propofo-assisted ERCP/EUS is very similar to midazolam/pethidine assisted surgery if administered by a specially trained nurse.

In conclusion, propofol has both advantages and disadvantages for wakeful sedation. More effective sedation is certainly highly desirable, especially for extended endoscopic procedures such as interventional EUS and therapeutic ERCP. Rapid patient turnover will improve the efficiency of endoscopy equipment. In addition, propofol had less lasting impact on patient function compared to midazolam. The recent problems with haloperidol have also raised our awareness that there are risks associated with current awake sedation measures for long-term surgery, and any improvements are welcome. However, propofol is a respiratory and cardiovascular inhibitor that does not contain antagonists. It is also an anesthetic, and abuse of it can put a patient into deep rather than awake sedation, which is the least desirable situation in the absence of an anesthesiologist. Study by Vargo et al.

It is suggested that propofol is safe and effective for gastroenterologists, but it is expensive. We anticipate that this will stimulate further controlled studies to assess the safety of propofol use by physicians and nurses with proper training." However, the jury is still out on the place of propofol in modern gastroenteroscopy.