Optimal sedation for gastrointestinal endoscopy: Review and recommendations

Abstract

Sedation practices for endoscopy vary widely. The present review focuses on the commonly used regimens in endoscopic sedation and the associated risks and benefits together with the appropriate safety measures and monitoring practices. In addition, alternatives and additions to intravenous sedation are discussed. Personnel requirements for endoscopic sedation are reviewed; there is evidence presented to indicate that non-anesthetists can administer sedative drugs, including propofol, safely and efficaciously in selected cases. The development of endoscopic sedation as a multi-disciplinary field is highlighted with the formation of the Australian Tripartite Endoscopy Sedation Committee. This comprises representatives of the Australian and New Zealand College of Anaesthetists, the Gastroenterological Society of Australia and the Royal Australasian College of Surgeons. Possible future directions in this area are also briefly summarized.

National Consensus on the Use of Sedation Drugs in the Gastrointestinal Endoscopic Procedures

“…3 According to guideline from American Society of Anesthesiologist (ASA), sedation and analgesia consist of a continuation of the patient's condition starting from minimal sedation (ansiolysis) to general anesthesia (Table 1). 8 Changes in sedation levels from conscious sedation to general anesthesia can occur unintentionally with little change in the dose of sedation used. …”

“…Patients with a history of heart or lung disease should have a continuous electrocardiography. 5,8 Patients with dehydration, obesity, and old age need special attention before the administration of sedation drugs.…”

“…More complicated (EUS and ERCP) or longer procedures need to be considered the use of deep sedation or anesthesia. 3,5,8,9 If endoscopist requires deep sedation, it should be considered consultation to a trained anesthesiologist/ non-anestesiologist. If endoscopist requires general anesthesia, it should be consulted to an anesthesiologist.…”

Sedation Related to Gastrointestinal Endoscopy

“…Ensuring an adequate sedation and analgesia influences some aspects of endoscopic procedures such as quality of examination, patient cooperation, patient and performing physician satisfaction (Bell, 2004). There are several practical issues with implications for endoscopic sedation (Thomson et al, 2010): www.intechopen.com…”

Gastrointestinal endoscopy in patients with obstructive sleep apnea syndrome

“…More recently, specific recommendations for the surgical care of patients with OSAS have been introduced in the guidelines of different anesthetic societies [4], in specific statements of management of patients with OSAS [5,6], and more recently in the standards of sedation of patients who undergo gastrointestinal endoscopy [7]. In this regard, the Clinical Practice Review Committee of the American Academy of Sleep Medicine [8] has recommended that patients with a high index of suspicion for OSAS who are undergoing surgical procedures have (1) airway monitoring throughout the surgical period, (2) judicious use of appropriate anesthetic medication, and (3) monitoring throughout the process, especially during the postoperative period.…”