Endoscopic Sedation: From Training to Performance

Abstract

Adequate sedation and analgesia are considered essential requirements to relieve patient discomfort and pain and ultimately to improve the outcomes of modern gastrointestinal endoscopic procedures. The willingness of patients to undergo sedation during endoscopy has increased steadily in recent years and standard sedation practices are needed for both patient safety and successful procedural outcomes. Therefore, regular training and education of healthcare providers is warranted. However, training curricula and guidelines for endoscopic sedation may have conflicts according to varying legal frameworks and/or social security systems of each country, and well-recognized endoscopic sedation training systems are not currently available in all endoscopy units. Although European and American curricula for endoscopic sedation have been extensively developed, general curricula and guidelines for each country and institution are also needed. In this review, an overview of recent curricula and guidelines for training and basic performance of endoscopic sedation is presented based on the current literature.

Efficacy of midazolam‐ versus propofol‐based sedations by non‐anesthesiologists during therapeutic endoscopic retrograde cholangiopancreatography in patients aged over 80 years

“…In the general population, endoscopic sedation based on balanced propofol sedation during therapeutic ERCP showed better sedation efficacy in terms of improved patient cooperation and patient satisfaction and decreased recovery time, compared with propofol monosedation. There was no significant difference in the rates of adverse events . Therefore, propofol‐based sedation was more efficacious with a similar safety profile during advanced endoscopic procedures compared with midazolam‐based sedation.…”

“…However, the method of endoscopic sedation differs according to country, health‐care system, cost, and preference. In general, propofol‐based sedation exhibits adverse event rates similar to those of benzodiazepines and provides better sedation quality, greater patient cooperation, and higher post‐procedural patient satisfaction for most endoscopic procedures . In addition, for advanced endoscopic procedures, compared with sedation by an anesthesiologist, NAAP has a similar level of safety but potentially lower patient and endoscopist satisfaction .…”

“…ERCP in older patients may take a longer time because of increased interventions, such as stent insertion or multiple stone removal, and requires less sedation. However, the known overall complication and mortality rates are comparable to those of younger patients …”

“…However, the known overall complication and mortality rates are comparable to those of younger patients. [1][2][3][4][5][6][7] Cardiopulmonary unplanned events under conscious sedation constitute a major proportion of ERCP-related complications (5.4-21.6 of 1000 cases) and mortalities (0.3-0.5 of 1000 cases). 3,[8][9][10][11][12] Moreover, older patients are more responsive to sedative hypnotics for conscious endoscopic sedation.…”

Propofol for gastrointestinal endoscopy

“…23 The guidelines of the Endoscopic Section of the German Society for Digestive and Metabolic Diseases suggest that for simple endoscopic examinations and in low-risk patients, sedation with propofol should be induced by a properly qualified physician and can then be monitored by an experienced person with appropriate training. The person must not have any other tasks while monitoring the sedation.…”