There is no doubt that the use of propofol is attractive, at least for ERCP and EUS, if not all standard endoscopies. Rapid induction of sedation and subsequent patient recovery will accelerate patient turnover, allowing for more surgery per treatment. Will this come at the expense of safety? According to several studies evaluating propofol for endoscopy, it doesn't seem to. Two large prospective studies (one randomized, 198 patients, and the other non-randomized, 274 patients) found that propofol was as safe as midazolam (or midazolam and pethidine) in waking sedation.

Two studies also found that patients treated with propofol had more effective sedation than those treated with benzodiazepines. In these studies and in the present study by Vargo et al. ,

Propofol is administered in pill form (usually 10-20 mg), usually after a load dose of 40 mg. Some have suggested that propofol should be titrated continuously rather than administered in pill form, as patients can easily obtain deep sedation through pill injections.

A pilot study has shown that it is safe and effective for patients to maintain sedation by target-controlled infusion of propofol.

However, there is no clear recommendation as to whether propofol should be titrated or given as a pill.

A key issue with propofol is the training requirements for those providing sedation and monitoring patients. In the two large studies, one employed an anesthesiologist nurse and the other a gastroenterologist familiar with the use of propofol.

The doctor was not involved in the actual endoscopic surgery. In Vargo et al. 's study, propofol was administered by an independent physician researcher who was specifically trained in propofol administration.