Sedation practices in gastrointestinal endoscopy—A survey from southern India

Abstract

Gastrointestinal endoscopies can cause an unpleasant experience for the patient. In India, most endoscopists follow a common institutional policy for sedation. The aim of this study was to analyze the sedation practices in various endoscopy centers across southern India. Data were collected with the help of a structured questionnaire given to a senior endoscopist of the center. Data from the completed questionnaire were later analyzed. Data were obtained from 19 centers across southern India. All endoscopy suites had central oxygen supply and emergency cart. A defibrillator was available in 12 centers (63.2%). Common criteria followed for administering sedation included therapeutic procedures (84.2%), patients who requested sedation (63.2%), children (63.2%), high-risk procedures (57.9%), and uncooperative patients (57.9%). Monitoring methods included pulse oximetry alone in six centers (31.6%), pulse oximetry with blood pressure monitoring in five centers (26.3%), and pulse oximetry, blood pressure, and electrocardiography (ECG) monitoring in eight centers (42.1%). For advanced procedures like endoscopic ultrasonography (EUS) and endoscopic retrograde cholangiopancreatography (ERCP), sedation was universally used. An anesthesiologist was available in the endoscopy suite in eight centers (42.1%). Five endoscopists administered propofol sedation without anesthesiologist's presence (26.3%). Thirteen centers had a written protocol for pre-procedure risk assessment (68.4%). A dedicated post-procedure observation area was available in seventeen centers (89.5%). Seven centers followed a written post-sedation discharge protocol (36.8%). Significant variations exist in the practice of sedation among endoscopists in southern India. There is an urgent need to formulate guidelines by endoscopy societies for ensuring better patient outcomes in endoscopy.

Impact of COVID-19 on gastrointestinal endoscopy practice in India: a cross-sectional study

“…Manual cleaning of endoscopes is being carried out in 46.6 %, and the automatic mode of cleaning in 13.9 % of endoscopy units, with the remainer (39.4 %) using both the methods. A similar practice also was reported in a survey from southern India that was done long before this pandemic [17].…”

National survey on sedation for gastrointestinal endoscopy in 2758 Chinese hospitals

“…There were 66.4% and 49.1% respondents who reported that their endoscopy centre had no access to airway devices or defibrillators, respectively. These proportions were higher than those in Greece 5 and south India, 7 and may put the patients at risk. In general, both the endoscopist and anaesthesiologist should be alert to the potentially fatal side-effects of endoscopic sedation and should consider safety parameters.…”