Update S3-guideline: “sedation for gastrointestinal endoscopy” 2014 (AWMF-register-no. 021/014)

Riphaus, A.; Wehrmann, T.; Hausmann, Johannes; Weber, Barbara; Delius, Stefan von; Jung, Maeng‐Joon; Tonner, Peter H.; Arnold, Jayantha; Behrens, Angelika; Beilenhoff, Ulrike; Bitter, H.; Domagk, Dirk; Smitten, S. In der; Kallinowski, B.; Meining, Alexander; Schaible, Anja; Schilling, Dieter; Seifert, H.; Wappler, Frank; Kopp, I.

doi:10.1055/s-0041-109680

Cited by 47 publications

(48 citation statements)

References 227 publications

(339 reference statements)

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“…Despite randomization, a higher number of patients received midazolam in addition to propofol in the capnography arm compared with standard monitoring (8% vs 0%), however, without statistically significant effect on hypoxia detection. Interestingly, although postinterventional recovery time can be prolonged, higher rates of hypoxemia have not been observed in studies evaluating the combination therapy of propofol and midazolam versus propofol monotherapy . Additionally, nurse‐administered propofol sedation is not allowed or common clinical practice in several countries.…”

Section: Discussionmentioning

confidence: 99%

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Capnography monitoring of non‐anesthesiologist provided sedation during percutaneous endoscopic gastrostomy placement: A prospective, controlled, randomized trial

Peveling‐Oberhag

Michael

Tal

et al. 2019

J of Gastro and Hepatol

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Background and Aim A number of studies were able to show a reduction of hypoxemia episodes during procedural sedation through the use of capnography (CA). The present study investigates the number of episodes of hypoxemia during percutaneous endoscopic gastrostomy (PEG) placement with propofol sedation comparing standard monitoring (SM) versus SM with additional CA surveillance. Methods In this single center randomized controlled trial, 150 patients were prospectively randomized 1:1 in either the SM group or the CA group after stratification for ASA class, PEG method (push or pull method), presence of head and neck tumor, and tracheostomy. CA analysis was performed for all patients but was blinded for the endoscopic team in the SM group. Results In the SM group, 57% episodes of hypoxemia (SpO2 < 90% for > 15 s) and 41% episodes of severe hypoxemia (SpO2 < 85% for > 15 s) were observed in comparison with 28% and 20% in the CA group, respectively. Odds ratios for hypoxemia and severe hypoxemia were 0.29 (confidence interval 0.15–0.57; P = 0.0005) and 0.35 (confidence interval 0.17–0.73; P = 0.008) in favor of the CA group. On average, CA was able to detect imminent mild and severe hypoxemia 83 and 99 s before standard monitoring. Standard monitoring represented an independent risk factor for hypoxemia and severe hypoxemia. Conclusions Respiratory complications of sedation during PEG placement are frequent events. CA is able to detect imminent hypoxemia at an early time point. This allows an early intervention and consecutively the avoidance of mild and severe hypoxemia. Therefore, CA monitoring can be recommended particularly during PEG insertion procedures.

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Section: Discussionmentioning

confidence: 99%

“…Upper GI interventional endoscopy procedures are routinely performed under endoscopic sedation by using propofol as the main sedative agent . However, the depth of sedation under propofol may vary, and cardiorespiratory side effects may occur .…”

Section: Introductionmentioning

confidence: 99%

Capnography monitoring of non‐anesthesiologist provided sedation during percutaneous endoscopic gastrostomy placement: A prospective, controlled, randomized trial

Peveling‐Oberhag

Michael

Tal

et al. 2019

J of Gastro and Hepatol

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“…Propofol is therefore recommended as the first choice over midazolam in currently published international guidelines 10 11 12. Also many editorials for sedation in gastrointestinal endoscopy have been published over the last decade, showing that non-anesthesiologist propofol sedation (NAPS) and in particular nurse-administered propofol sedation (NAAP) is safe when performed by trained staff 13 14 also when compared to anesthesiologist-administered sedation in a low-risk population 15 16.…”

mentioning

confidence: 99%

“…However, all currently available national and international guidelines, including the European guideline with anaesthesiologist in the committee, were focusing on patient safety as a precondition without any exception when sedation for gastrointestinal endoscopy is performed by non-anesthesiologists 10 11 12 24 25. This underscores the total agreement between gastroenterologists and anesthesiologists focusing on patient safety as the main goal.…”

mentioning

confidence: 99%

“…This underscores the total agreement between gastroenterologists and anesthesiologists focusing on patient safety as the main goal. The best example in this context is the German guideline 12, showing that cooperation instead of defense might be an ideal option regarding guideline development and coordinating nationwide training courses under well-defined conditions 26 27. One reason that this concept is successful might be the fact that in Germany there is no reimbursement when an anesthesiologist performs propofol sedation in the ambulatory or hospital setting, whereas in other countries, an attractive reimbursement is given.…”

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confidence: 99%

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