https://www.giejournal.org/article/S0016-5107(11)02176-6/pdf

Obesity as a risk factor for sedation-related complications during propofol-mediated sedation for advanced endoscopic procedures.

Background Service models for gastrointestinal endoscopy sedation must be safe, as endoscopy is the most common procedure performed under sedation in many countries. The aim of this prospective cohort study was to determine the patient risk profile, and incidence of and risk factors for significant unplanned events, in adult patients presenting for gastrointestinal endoscopy in a group of university-affiliated hospitals where most sedation is managed by anaesthetists. Methods Patients aged ≥18 yr presenting for elective and emergency gastrointestinal endoscopy under anaesthetist-managed sedation at nine hospitals affiliated with the University of Melbourne, Australia, were included. Outcomes included significant airway obstruction, hypoxia, hypotension and bradycardia; unplanned tracheal intubation; abandoned procedure; advanced life support; prolonged post-procedure stay; unplanned over-night admission and 30-day mortality. Results 2,132 patients were included. Fifty percent of patients were aged >60 yr, 50% had a BMI >27 kg m −2, 42% were ASA physical status III-V and 17% were emergency patients. The incidence of significant unplanned events was 23.0% (including significant hypotension 11.8%). Significant unplanned intraoperative events were associated with increasing age, BMI  Conclusions Patients presenting for gastrointestinal endoscopy at a group of public university-affiliated hospitals where most sedation is managed by anaesthetists, had a high risk profile and a substantial incidence of significant unplanned intraoperative events and 30-day mortality.

Safety of sedation for gastrointestinal endoscopy in a group of university-affiliated hospitals: a prospective cohort study†

Sedation is commonly used in gastrointestinal endoscopy; however, considerable variability in sedation practices has been reported. The objective of this review was to identify and synthesize existing recommendations on sedation practices for routine gastrointestinal endoscopy procedures. We systematically reviewed guidelines and position statements identified through a search of PubMed, guidelines databases, and websites of relevant professional associations from January 1, 2005 to May 10, 2019. We included English-language guidelines/position statements with recommendations relating to sedation for adults undergoing routine gastrointestinal endoscopy. Documents with guidance only for complex endoscopic procedures were excluded. We extracted and synthesized recommendations relating to: 1) choice of sedatives, 2) sedation administration, 3) personnel responsible for monitoring sedated patients, 4) skills and training of individuals involved in sedation, and 5) equipment required for monitoring sedated patients. We assessed the quality of included documents using the Appraisal of Guidelines for Research & Evaluation (AGREE) II tool. We identified 19 guidelines and 7 position statements meeting inclusion criteria. Documents generally agreed that a single, trained registered nurse can administer moderate sedation, monitor the patient, and assist with brief, interruptible tasks. Documents also agreed on the routine use of pulse oximetry and blood pressure monitoring during endoscopy. However, recommendations relating to the drugs to be used for sedation, the healthcare personnel capable of administering propofol and monitoring patients sedated with propofol, and the need for capnography when monitoring sedated patients varied. Only 9 documents provided a grade or level of evidence in support of their recommendations. Recommendations for sedation practices in routine gastrointestinal endoscopy differ across guidelines/position statements and often lack supporting evidence with potential implications for patient safety and procedural efficiency.

/pdf/sedation-practices-for-routine-gastrointestinal-endoscopy-a-nzxx9v2to1.pdf

Sedation practices for routine gastrointestinal endoscopy: a systematic review of recommendations

Sedation for gastrointestinal endoscopic procedures has become indispensable, hence sedation is now a mandatory requirement to be offered to all patients before an endoscopic exam following the discussion of its benefits, risks, drawbacks, and alternative options. Patient sedation pursues a dual purpose – on the one hand the achievement of a good perceived quality by suppressing pain; on the other hand an avoidance of untimely movements that may compromise efficacy and safety. In the past twenty years a huge amount of papers were published showing that properly trained non-anesthetist doctors and nurses may effectively, safely, and efficiently take responsibility for the administration of sedatives and painkillers, as well as patient monitoring during endoscopy. Also, major scientific societies involved in gastrointestinal endoscopy have published guidelines with recommendations in this respect. The Sociedad Española de Endoscopia Digestiva (SEED) is no exception and published in 2006 their sedation guidelines, which included all major indications, contraindications, drug classes, and other related topics [1]. Presently, the SEED Board of Directors has decided to update these guidelines by publishing a new version with revised major aspects and the addition of recent findings.

/pdf/sedation-for-gastrointestinal-endoscopy-3ycqi0fjdd.pdf

Sedation for gastrointestinal endoscopy

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.

/pdf/sedation-regimens-for-gastrointestinal-endoscopy-2gn39jtnog.pdf

Sedation Regimens for Gastrointestinal Endoscopy

Balanced propofol sedation for therapeutic GI endoscopic procedures: a prospective, randomized study

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Balanced propofol sedation for therapeutic GI endoscopic procedures: a prospective, randomized study