Safety, Efficacy and High-Quality Standards of Gastrointestinal Endoscopy Procedures in Personalized Sedoanalgesia Managed by the Gastroenterologist: A Retrospective Study

Abstract

Performing GI endoscopy under sedoanalgesia improves the quality-indices of the examination, in particular for cecal intubation and adenoma detection rates during colonoscopy. The implementation of procedural sedoanalgesia in GI endoscopy is also strongly recommended by the guidelines of the major international scientific societies. Nevertheless, there are regional barriers that prevent the widespread adoption of this good practice. A retrospective monocentric analytic study was performed on a cohort of 529 patients who underwent EGDS/Colonoscopy in sedoanalgesia, with personalized dosage of Fentanyl and Midazolam. ASA class, age and weight were collected for each patient. The vital parameters were recorded during, pre- and post-procedure. The rates of cecal intubation and of procedure-related complications were entered. The VAS scale was used to evaluate the efficacy of sedoanalgesia, and the Aldrete score was used for patient discharge criteria. No clinically significant differences were found between vital signs pre- and post-procedure. Both anesthesia and endoscopic-related complications occurring were few and successfully managed. At the end of examination, both the mean Aldrete score (89.56), and the VAS score (<4 in 99.1%) were suitable for discharge. For the colonoscopies, the cumulative adenoma detection rate (25%) and the cecal intubation rate in the general group (98%) and in the colorectal cancer screening group (100%) were satisfying. Pain control management is an ethical and medical issue aimed at increasing both patient compliance and the quality of the procedures. The findings of this work underscore that in selected patients personalized sedoanalgesia in GI endoscopy can be safely managed by gastroenterologists.

Procedural Sedation in Emergency Department: A Narrative Review

“…A crucial step to decrease sedation-related adverse events includes a globally unified approach and precise decision-making criteria for involving an anesthesiologist. Sedation is nowadays used for an ample range of procedures in various specialties, many of which are performed by nonanesthesiologists, such as dental care, cardiology, gastroenterology [151], emergency medicine. The techniques used in these different fields are effective for most of the patients, however, the limitations of setting, comorbidities, advanced/multiple drug use suggest the absolute need of a specialized and adequately trained individual responsible for monitoring the patient [152].…”

Procedural Sedation in Emergency Department: A Narrative Review

“…A crucial step to decrease sedation-related adverse events includes a globally unified approach and precise decision-making criteria for involving an anesthesiologist. Sedation is nowadays used for an ample range of procedures in various specialties, many of which are performed by non-anesthesiologists, such as dental care, cardiology, gastroenterology [146], and emergency medicine. The techniques used in these different fields are effective for most of the patients.…”

Up-to-date literature review and issues of sedation during digestive endoscopy.

“…Some of these factors are patient-related and include old age (> 70 years old), decreased O 2 saturation (< 95%), ASA III and IV, hospitalization, associated lung diseases, and having a history of arrhythmia and ischaemic heart diseases [17,20,[30][31][32]. Other factors are procedure related and are usually associated with oral endoscopy, emergency procedures, the status of O 2 administration, and drug dosage [33][34][35][36]. Therefore, relevant national guidelines from different societies recommend looking for these factors before sedation, to reduce the risk of complications and enhance management practices [5,25].…”