Sedation Regimens for Gastrointestinal Endoscopy

Abstract

Sedation allows patients to tolerate unpleasant endoscopic procedures by relieving anxiety, discomfort, or pain. It also reduces a patient's risk of physical injury during endoscopic procedures, while providing the endoscopist with an adequate setting for a detailed examination. Sedation is therefore considered by many endoscopists to be an essential component of gastrointestinal endoscopy. Endoscopic sedation by nonanesthesiologists is a worldwide practice and has been proven effective and safe. Moderate sedation/analgesia is generally accepted as an appropriate target for sedation by nonanesthesiologists. This focused review describes the general principles of endoscopic sedation, the detailed pharmacology of sedatives and analgesics (focused on midazolam, propofol, meperidine, and fentanyl), and the multiple regimens available for use in actual practice.

Alternative sedation regimens for upper gastrointestinal endoscopy proven to be safe. A retrospective comparative study

“…[6] Although meperidine produces only mild hemodynamic depression, addition of meperidine to propofol may potentiate hypotension due to synergic action. [32] Previous studies have revealed that the use of larger initial bolus doses of propofol was associated with higher incidence of hypotension.…”

“…[6] Although meperidine produces only mild hemodynamic depression, addition of meperidine to propofol may potentiate hypotension due to synergic action. [32] Previous studies have revealed that the use of larger initial bolus doses of propofol was associated with higher incidence of hypotension. [22][23][24][25][26][27][28][29][30] Hsieh et al [21] reported hypotension incidence as 23% for an initial bolus of 1 mg/kg propofol, which was then titrated in 10-20 mg increments plus 25 mg of meperidine (dose of propofol, 129.80±37.93 mg).…”

“…[11] Ketamine is not frequently used for sedation in digestive endoscopy. [5][6][7] The use of ketamine combined with propofol has been studied mainly for procedural sedations in emergency department and pediatric settings, and there are limited data concerning sedation in upper gastrointestinalendoscopy. [8,12] In our endoscopy unit, EGD is not routinely performed under sedation; it is only performed for patients who request sedation.…”

“…Furthermore, propofol sedation for EGD is associated with increased incidence of cardiopulmonary events in a dosedependent manner. [6,7] The combination of propofol and ketamine or an opioid reduces the side effects , improves the quality of the cardiopulmonary sedation and analgesia, and decreases the propofol requirement for procedural sedation compared with propofol alone. [8,9] Pethidine is an opioid receptor antagonist that is widely used as an adjunct for endoscopic sedation.…”

Propofol for gastrointestinal endoscopy

“…The onset of effect for propofol is 0.5-1 minute, and the duration of effect is 4-8 minutes. 5 The pharmacokinetic parameters of propofol vary with patient factors such as weight, sex and age. The dose should be reduced in elderly patients.…”