PURPOSE: To determine the suitability of the routine use of propofol as the sole agent for sedation as given by specially trained RNs. METHODS: After focused training by one anesthesiologist, four hand-picked RN's provided propofol sedation according to our protocol at an ambulatory surgery center to 1,424 consecutive patients. Monitoring parameters and clinical assessment were studied. A questionnaire was mailed to the first 370 patients and given prospectively to the rest. RESULTS: During colonoscopy one patient developed a drop in systolic pressure to 86, which was subclinical and which responded quickly to ephedrine. There were no other complications potentially related to sedation. 84% of respondents who had had previous traditional sedation said propofol sedation was superior. A global satisfaction score of 9.5 (1 -10) was observed in these patients who ranged in age from 17 to 93 (average age 65). Approximately two of three patients felt like they could drive safely within two hours. Not a single patient had pain during the procedures nor was there any recall of the procedure. 3% of patients had gas distention discomfort in the recovery area. 76% of patients resumed full work or full leisure activity within two hours. 89% had a fair or excellent memory of what the physician said prior to discharge (usually within 25 minutes). 91% of patients said propofol sedation would make screening colonoscopy more acceptable. The cost of propofol sedation was identical to traditional sedation. Recovery times were far shorter with propofol. CONCLUSION: Propofol for endoscopy and colonoscopy, according to our protocol, is safe, effective, efficient and popular. This study was funded in part by a grant from AstraZeneca.