Alexander A. Hannenberg, MD
Potential Conflicts of Interest: None disclosed.
Hannenberg A.; Effect of the Centers for Medicare & Medicaid Services Policy About Deep Sedation on Use of Propofol. Ann Intern Med. 2011;155:405. doi: 10.7326/0003-4819-155-6-201109200-00020
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Published: Ann Intern Med. 2011;155(6):405.
TO THE EDITOR:
Rex's article (1) on Medicare policy as it affects use of propofol for procedural sedation confuses the standards set by the Centers for Medicare & Medicaid Services (CMS) for deep sedation. The author, like any physician—anesthesiologist or not—is permitted under Medicare policy to administer deep sedation or general anesthesia if his or her facility has been granted privileges for doing so. The CMS does not forbid gastroenterologists from administering sedatives and anesthesia, but it does forbid them from delegating this responsibility to an endoscopy nurse while occupied with the endoscopy procedure—a policy shared by dozens of state nursing boards. The U.S. Food and Drug Administration's “black box” warning for propofol forbids its use while performing a procedure, such as endoscopy. This reflects the judgment that the administration of such potent drugs requires the undivided attention of the responsible physician. The Institute for Safe Medication Practices, the American Society of Anesthesiologists (ASA), and other groups take the same view on the hazard of multitasking with deep sedation or anesthesia.
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