Expert: Ronald Levy, M.D. - 5/6/2008

Question
In a couple of weeks I will be having my wisdom teeth extracted.  The oral surgeon I am seeing normally uses the Versed/Fentanyl combo for this surgery, but I advised him that I cannot tolerate benzodiazepines, narcotics, barbiturates, etc., so he agreed to use Propofol instead, which is what my gastroenterologist used when I had my last colonoscopy and it worked very well for me.  My question is this: I've heard that Propofol should only be administered by an anesthesiologist or nurse anesthetist, not the practitioner who is performing the actual procedure.  However, the oral surgeon that I am seeing does not have an anesthesiologist or nurse anesthetist on his staff.  Is this safe?  I know the oral surgeon has some training in anesthesiology, but according to what I've read, there is some uncertainty about whether the practitioner performing the procedure can adequately monitor the effects of the Propofol while performing the procedure.  Thanks in advance for any insight you can provide on this subject.

Answer
Each state law is different but if your oral surgeon has had proper training in the use of Propofol (and they usually have a nurse that assists them), then it is OK for them to use it. They should (at a minimum) monitor your oxygen saturation (a clip they put on your finger), your EKG and blood pressure.

Ronald Levy, MD
Associate Professor of Anesthesiology
UTMB-Galveston