So our Chief MDA does not believe we should be "snowing" patients with propofol for endos. I essentially do a room air general when I do these cases and my patients and GI docs are happy. Our chief feels that it is just a matter of time before someone aspirates or loses an airway etc. My argument was that alot of our GI docs flip out if the patient even flinches and with mild propofol sedation they are still going to move especially if belly pressure is needed to advance the scope. He also would like us to use a pump as opposed to hand titrating.

How do the rest of you do these cases and what are your thoughts on my practice?