Propofol infusion platforms: opportunities and challenges

Several propofol infusion platforms have been devised to address the inherent safety problems associated with propofol administration. Patient-controlled and target-controlled infusion systems have been described in the literature, and the Sedasys closed-loop feedback system is in FDA review. No matter what the infusion platform, there are important safety concerns that should be addressed whenever propofol is administered by non-anesthesiologists. There must be safeguards in the facility's sedation protocol for non-anesthesiologists that involve training, documentation, auditing/oversight, quality improvement and involvement of the facility's pharmacy and therapeutics committee. Definitions of levels of sedation and recommendations from the American Society of Anesthesiologists on rescue, identification and management of potential complications, as well as monitoring and training of personnel are also presented.