Nurses have been given the green light to perform procedural sedation of patients using propofol provided they work under a strict set of guidelines released by the Australian and New Zealand College of Anaesthetists.
It follows a declaration by the college that while the practice cannot be deemed completely safe, models of propofol sedation by non-anaesthetists are already widespread and “may be acceptable” with appropriate training, personnel and support systems.
The first update to the official guidance (link here) since 2014, the document’s publication follows more than 12 months of consultation involving 29 colleges and specialty groups across Australia and New Zealand.
Labelled PG09(G), it is now being introduced as a six-month pilot, allowing ANZCA to gather feedback before a finalised document is published later this year.
Other key changes include:
- Updated definitions for minimal, moderate and deep sedation, plus specific wording excluding deep sedation from the guidance given the risks of progression to general anaesthesia.
- Specific guidance addressing paediatric sedation
- A shift in focus from the seditionist’s profession to their competency, with an expectation that practitioners achieve and demonstrate competency with their targeted depth, plus one level deeper, in case of unintentionally exceeding the targeted depth.
“Medical practitioners from many disciplines, nurses, dentists and dental specialists administer sedative/hypnotic medications,” a background paper released alongside the guideline states.
“The purpose of PG09(G) is to optimise patient care in the management of procedural sedation by all sedationists.”
The document goes on to state there is little evidence of a significant difference in outcomes when propofol is used for minimal or moderate sedation by anaesthetists compared to other medical practitioners and dentists.
Nevertheless, the guideline goes on to say that as the administration of any medication carries a risk of adverse events, it would be inappropriate to consider and technique “safe”.