ASK FOR IT BY NAME: PROPOFOL

As an emergency physician usually a patient asking for a specific drug by name is a red flag. Often that request is pain related: “The only drug that works for me is the one that starts with a D…”. Of course they are referring to dilaudid, a potent narcotic. However, seeing this article — “Propofol as Safe as Traditional Anesthesia for GI Endoscopy” — makes me want to tell patients scheduled for colonoscopy to ask for it by name: Propofol (Diprivan)

Colonosopy-for-cancerThe number of people needing a colonoscopy for cancer screening grows everyday as our population ages. Unfortunately, many – even after they are scheduled by their primary care doctor – don’t show up for the test (Solving Endoscopy No-shows). It’s not hard to understand why so many people don’t get scoped: “you’re putting that “hose” where doctor??!!”. Interestingly, after the scope, if there is any complaint, it is typically related to the prep (i.e. taking some laxatives to clean the colon the day before the procedure) and not about the procedure itself. Anyone that has had the “hose” will tell you they simply don’t remember it. The reason they don’t remember it is conscious sedation: medications administered through an IV keeping them unaware/asleep during the procedure.

In the emergency department we’ve been using propofol for conscious sedation for quite some time, but we don’t have any “hoses”, at least for use in colonoscopies. We just do things like reduce shoulder dislocations or set broken bones, place tubes between ribs in people’s chests (chest tube) and a myriad of other intrusive and painful procedures. Using propofol makes life better for everyone: patients and providers alike. Patients in pain can be instantly relaxed and relatively unaware as propofol is easily administered through an IV. Providers can get the procedures done more easily and propofol wears off so quickly that the patient can be dispositioned sooner without lengthy periods of recovery.

While gastroenterologists have historically used other medications to sedate patients, propofol could make things a lot better for everyone involved (e.g. decreased “no-shows” and improved quality scores). Many of the older drugs have sedative and amnestic effects that are slow in onset (e.g. you might not quite be asleep when the “exit” becomes an “entrance”) and can last several hours after use (e.g. being home after the procedure trying to remember your own name). With this new study showing it to be as safe as older drugs, while working and wearing off more quickly, propofol might help entice more people into actually having their colonoscopy.  And with propofol you won’t even remember the “hose”. Ask for propofol by name.