Overview of procedural sedation for gastrointestinal endoscopy
- Jonathan Cohen, MD
Jonathan Cohen, MD
- Clinical Professor of Medicine
- New York University School of Medicine
- Section Editors
- John R Saltzman, MD, FACP, FACG, FASGE, AGAF
John R Saltzman, MD, FACP, FACG, FASGE, AGAF
- Section Editor — Therapeutic and Diagnostic Endoscopy
- Professor of Medicine
- Harvard Medical School
- Girish P Joshi, MB, BS, MD, FFARCSI
Girish P Joshi, MB, BS, MD, FFARCSI
- Section Editor — Fundamentals of Anesthesia
- Professor of Anesthesiology and Pain Management, Director of Perioperative Medicine and Ambulatory Anesthesia
- University of Texas Southwestern Medical Center at Dallas
The development of gastrointestinal endoscopy has greatly expanded the diagnostic and therapeutic capabilities of gastroenterologists. Adequate patient tolerance is essential for the successful completion of a safe examination and compliance with subsequent follow-up. As a result, endoscopists have developed skills in administering a variety of sedative and analgesic agents to facilitate procedures and enhance patient comfort.
This topic review will focus on standard methods of procedural sedation. Adverse events related to sedation, issues related to endoscopic procedures without sedation, and the management of patients who are difficult to sedate are discussed elsewhere. (See "Adverse events related to procedural sedation for gastrointestinal endoscopy" and "Sedation-free gastrointestinal endoscopy" and "Alternatives and adjuncts to moderate procedural sedation for gastrointestinal endoscopy".)
PRE-PROCEDURE PREPARATION AND ASSESSMENT
All patients undergoing gastrointestinal endoscopy should be assessed with a history and physical examination prior to administering sedation to identify factors that increase the risk of an adverse outcome. (See "Adverse events related to procedural sedation for gastrointestinal endoscopy".)
The history should determine if any of the following are present:
●Significant cardiac or pulmonary disease
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- PRE-PROCEDURE PREPARATION AND ASSESSMENT
- LEVELS OF SEDATION
- SUPPLEMENTAL OXYGEN
- SEDATIVES AND ANALGESICS
- Choice of medications
- - Patient-related considerations
- - Procedure-related considerations
- Pharyngeal anesthesia
- Intravenous agents
- - Benzodiazepines
- - Opiates
- - Propofol
- PREGNANCY AND LACTATION
- ADVERSE EVENTS
- POST-PROCEDURE MONITORING
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS