Level of Intended Sedation

Paspatis, Gregorios A.; Tribonias, George; Paraskeva, Konstantina

doi:10.1159/000285504

Cited by 9 publications

(5 citation statements)

References 29 publications

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“…According to the Standards of Practice Committee of the American Society for Gastrointestinal Endoscopy (ASGE), “sedation may be defined as a drug-induced depression in the level of consciousness” 17 . Sedation and analgesia for GIE aim to relieve the patient’s anxiety, fear and pain, minimize discomfort, improve the outcome of the examination, and diminish the patient’s recollection of the event 16 17 22 23 24 25 26 . Although their use improves tolerance and acceptance of the examination, they increase the cost and are responsible for about 50 % of all GIE complications 20 22 27 28 .…”

Section: Discussionmentioning

confidence: 99%

Sedation in gastrointestinal endoscopy: a prospective study comparing nonanesthesiologist-administered propofol and monitored anesthesia care

Paulo

Martins

Macedo

et al. 2015

EIO

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Introduction: Adequate sedation is one of the cornerstones of good quality gastrointestinal endoscopy (GIE). Propofol sedation has increased significantly but there has been much debate over whether it can be administered by endoscopists. The aim of this prospective trial was to compare nonanesthesiologist-administered propofol (NAAP) and monitored anesthesia care (MAC). Methods: A total of 2000 outpatients undergoing GIE at Hospital Albert Einstein (São Paulo, Brazil), a tertiary-care private hospital, were divided into two matched groups: NAAP (n = 1000) and MAC (n = 1000). In NAAP, propofol doses were determined by the endoscopist. A second physician stayed in the room during the entire procedure, according to local regulations. In MAC, the anesthesiologist administered propofol. Results: In total, 1427 patients (71.3 %) were ASA (American Society of Anesthesiologists) class I and 573 were ASA class II. In NAAP, patients received more propofol + fentanyl (61.1 % vs. 50.5 %; P < 0.05) and there were fewer cases of deep sedation (44.7 % vs. 66.1 %; P < 0.05). Hypoxemia rates were similar (12.8 % for NAAP and 11.2 % for MAC; P = 0.3) but these reverted more rapidly in MAC (4.22 seconds vs. 7.26 seconds; P < 0.05). Agitation was more frequent in MAC (14.0 % vs. 5.6 %; P < 0.05). No later complications were observed. Patient satisfaction was very high and similar in both groups. Conclusion: In this setting, NAAP was as safe and effective as MAC for healthy patients undergoing GIE.Clinical trial ref. no.: U1111-1134-4430

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Section: Discussionmentioning

confidence: 99%

Sedation in gastrointestinal endoscopy: a prospective study comparing nonanesthesiologist-administered propofol and monitored anesthesia care

Paulo

Martins

Macedo

et al. 2015

EIO

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“…Deciding on whether to use moderate, deep sedation or general anesthesia depends on patient characteristics, procedure demands and existence of the required structural conditions [9,10] . Common practice is the performance of ERCP under conscious sedation so most of the studies are targeted to a moderate level of sedation.…”

Section: Deciding On the Level Of Sedationmentioning

confidence: 99%

Deep sedation for endoscopic retrograde cholangiopacreatography

Chainaki¹

2011

WJGE

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Sedation and analgesia comprise an important element of unpleasant and often prolonged endoscopic retro grade cholangiopacreatography (ERCP), contributing, however, to better patient tolerance and compliance and to the reduction of injuries during the procedure due to inappropriate cooperation. Although most of the studies used a moderate level of sedation, the lite rature has revealed the superiority of deep sedation and general anesthesia in performing ERCP. The anes thesiologist's presence is mandatory in these cases. A moderate sedation level for ERCP seems to be adequate for octogenarians. The sedative agent of choice for sedation in ERCP seems to be propofol due to its fast distribution and fast elimination time without a cumu lative effect after infusion, resulting in shorter recovery time. Its therapeutic spectrum, however, is much nar rower and therefore careful monitoring is much more demanding in order to differentiate between moderate, deep sedation and general anesthesia. Apart from con ventional monitoring, capnography and Bispectral index or Narcotrend monitoring of the level of sedation seem to be useful in titrating sedatives in ERCP.

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“…Endoscopists and nursing stuff should be board certified in intensive medicine and resuscitation to ensure the patient’s comfort and safety. The providers should be properly trained in the administration of endoscopic sedation and should possess the skills necessary for the diagnosis and management of sedation-related adverse events, including rescue from a level of sedation deeper than that intended [ 57 , 58 ]. Greek studies have shown that propofol-based sedation has not largely been adopted by the endoscopic community, mainly because of medicolegal reasons and inadequate training [ 31 , 59 ].…”

Section: Introductionmentioning

confidence: 99%