Austrian Society of Gastroenterology and Hepatology (ÖGGH) - Guidelines on sedation and monitoring during gastrointestinal endoscopy

Deep sedation for endoscopic retrograde cholangiopacreatography

“…According to Austrian guidelines [39] , as regards sedation in endoscopy, deep sedation and propofol use require the existence of special equipment in the endoscopy suite. Specifically, equipment for mask respiration and endotra cheal intubation must be available; the medication for resu scitation should be at hand and there should be oxygen and vacuum connections.…”

Level of Intended Sedation

“…Even for a purely diagnostic endoscopy, sedation can be advantageous, not only for the patient, but also in terms of achievement of higher-quality procedures. The following list summarizes the endoscopic procedures which most often require the use of sedation or deep sedation [3]: interventional endoscopy in the upper gastrointestinal tract (hemostasis; treatment of varices with ligation, sclerotherapy, or tissue-adhesive therapy; dilation procedures; implantation of prostheses; endoscopic mucosal resection; and disobliteration procedures); diagnostic and interventional endosonography; percutaneous endoscopic gastrostomy; colonoscopy with difficult and/or multiple polypectomy or with endoscopic mucosal resection; and ERCP with interventions involving the bile ducts (endoscopic papillotomy, mechanical lithotripsy, stone removal, implantation of prostheses) and the pancreatic ducts (selective sphincterotomy, stone removal, dilation, implantation of prostheses).…”

“…In all cases when a patient has an increased risk, or when a long, complex intervention is expected, a second person qualified in resuscitation and intensive care with the sole task of administering the sedation and monitoring the patient should be present [3,10,12]. According to published data, this person can be an anesthesiologist, a specially trained physician or a specially trained member of the nursing staff [3].…”

“…According to published data, this person can be an anesthesiologist, a specially trained physician or a specially trained member of the nursing staff [3]. Physicians who are not anesthesiologists are not allowed to perform sedation and/or analgesia procedures that would reach a planned degree of sedation that affects or eliminates life-preserving reflexes.…”

“…Unsedated endoscopy is feasible in selected patients, but requires commitment from both the patient and the provider [1,2]. With purely diagnostic gastroscopy, the use of sedatives involves a slightly higher rate of complications, but patient acceptance is significantly higher than without [3]. Every patient has the right to an endoscopic examination that is as painless and stress-free as possible.…”