Sedation in gastrointestinal endoscopy: Current issues

Abstract

Diagnostic and therapeutic endoscopy can successfully be performed by applying moderate (conscious) sedation. Moderate sedation, using midazolam and an opioid, is the standard method of sedation, although propofol is increasingly being used in many countries because the satisfaction of endoscopists with propofol sedation is greater compared with their satisfaction with conventional sedation. Moreover, the use of propofol is currently preferred for the endoscopic sedation of patients with advanced liver disease due to its short biologic half-life and, consequently, its low risk of inducing hepatic encephalopathy. In the future, propofol could become the preferred sedation agent, especially for routine colonoscopy. Midazolam is the benzodiazepine of choice because of its shorter duration of action and better pharmacokinetic profile compared with diazepam. Among opioids, pethidine and fentanyl are the most popular. A number of other substances have been tested in several clinical trials with promising results. Among them, newer opioids, such as remifentanil, enable a faster recovery. The controversy regarding the administration of sedation by an endoscopist or an experienced nurse, as well as the optimal staffing of endoscopy units, continues to be a matter of discussion. Safe sedation in special clinical circumstances, such as in the cases of obese, pregnant, and elderly individuals, as well as patients with chronic lung, renal or liver disease, requires modification of the dose of the drugs used for sedation. In the great majority of patients, sedation under the supervision of a properly trained endoscopist remains the standard practice worldwide. In this review, an overview of the current knowledge concerning sedation during digestive endoscopy will be provided based on the data in the current literature.

Sedation-related complications in gastrointestinal endoscopy

“…Prevention or minimization of myocardial ischemia/ infarction during GIE procedure: (1) pre-oxygenation in at risk patients and give continuous supplemental oxygen; (2) give patients their normal anti-hypertensive and/or antianginal therapy right up to the time of the endoscopy; (3) angina developing during an endoscopy is usually best managed by giving sublingual nitroglycerine, oxygen supplementation and discontinuing the examination; and (4) if angina or myocardial infarction is suspected during or following an endoscopy, arrange an ECG to exclude an myocardial infarction.…”

“…These procedures have been shown to cause various effects on cardiorespiratory systems, which can increase the risks of the procedure in patients with underlying cardiorespiratory diseases [1,2] . Additionally, complications attributed to moderate and deep sedation levels are more often associated with cardiovascular and respiratory systems.…”

Sedation-related Adverse Events Associated with a Diagnostic Upper Endoscopy: A Single Center-observational Study

“…3 의식하 진정과 관련된 주요 이상 반 응으로는 저산소증, 저혈압, 고혈압, 역설 반응, 부정맥 등이 있 으며 1,000명당 1명 정도에서는 심정지, 급성 심근경색, 아나 필락시스 등의 심각한 심폐 이상 반응이 나타나는 것으로 보고 되고 있다. 1,6,7 따라서 의식하 진정 내시경을 수행할 때에는 나 타날 수 있는 이상 반응의 종류 및 회복 방법을 숙지하고, 신속 하게 적절한 대처를 할 수 있도록 충분한 대비가 필요하다. 그 러나 이러한 의식하 진정 관련 이상 반응에 대하여 국내에서 보고된 연구는 드문 실정이다.…”

Sedation for Pediatric Patient with End-Stage Hepatic Disease Outside Operating Room

“…According to the protocol used in the institution their doses alone and in combination with other anesthetics differ. But the main consensus is titration of the drugs after a low dose given in a short time [14].…”