Nurse-administered propofol sedation for upper endoscopic ultrasonography: not yet ready for prime time

In nurse-administered propofol sedation (NAPS), a nurse working under the supervision of an endoscopist is delegated responsibility for administration of propofol to a patient and monitoring their sedation during endoscopy. Nursing personnel and endoscopists involved in NAPS receive specialized training, and more than 400,000 reported procedures (mostly esophagogastroduodenoscopies and colonoscopies) have used NAPS. The safety record of NAPS is comparable if not superior to that of standard sedation using an opioid and a benzodiazepine. A study by Fatima et al. attempts to expand the breadth of NAPS applications by testing the safety of the procedure in endoscopic ultrasonographies. This commentary discusses the results reported by Fatima et al., and urges clinicians to interpret this study's findings with caution. Further evidence that NAPS can be implemented for endoscopic ultrasonography in settings other than major hospitals with a full complement of services is necessary before its use can be recommended to community-based practices.