title: Effect of the Centers for Medicare & Medicaid Services policy about deep sedation on use of propofol.
abstract: On 11 December 2009, the Centers for Medicare & Medicaid Services issued a policy stating that deep sedation can only be administered by an anesthesiologist, a certified registered nurse anesthetist, or a trained medical doctor or a doctor of osteopathy not involved in the performance of a medical procedure. Propofol is a popular sedation agent that is usually administered by anesthesia specialists in a service termed monitored anesthesia care (MAC). Monitored anesthesia care adds substantial new fees to procedural sedation. However, available evidence shows that propofol can be used safely by non-anesthesiologists for procedural sedation. The American Society of Anesthesiologists considers that propofol implies deep sedation and should only be administered by anesthesia specialists. The Centers for Medicare & Medicaid Services policy on deep sedation can be viewed as supporting an ongoing conversion to MAC to deliver propofol for procedural sedation. However, the absence of an evidence base supporting a need for MAC to deliver propofol, combined with its high cost, suggests that alternatives to MAC to deliver propofol deserve fair and balanced evaluation.
authors.affiliation: Indiana University Hospital, 550 North University Boulevard, Indianapolis, IN 46202, USA. drex@iupui.edu
authors.forename: Douglas K
authors.initials: DK
authors.lastname: Rex
mesh_terms: D018686:Anesthetics, Intravenous / Q000008:administration & dosage* / Q000191:economics; D054810:Deep Sedation / Q000191:economics* / Q000379:methods*; D016903:Drug Monitoring / Q000191:economics*; D019317:Evidence-Based Medicine; D006801:Humans; D008484:Medicaid; D006278:Medicare; D017410:Practice Guidelines as Topic; D015742:Propofol / Q000008:administration & dosage* / Q000191:economics; D014481:United States
chemical_list: D018686:Anesthetics, Intravenous; D015742:Propofol