Overview of procedural sedation for gastrointestinal endoscopy
- Jonathan Cohen, MD
Jonathan Cohen, MD
- Clinical Professor of Medicine
- New York University School of Medicine
The development of gastrointestinal endoscopy has greatly expanded the diagnostic and therapeutic capabilities of gastroenterologists. Adequate patient tolerance is essential for 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. Complications related to sedation, issues related to endoscopic procedures without sedation, and the management of patients who are difficult to sedate are discussed elsewhere. (See "Complications of procedural sedation for gastrointestinal endoscopy" and "Sedation-free gastrointestinal endoscopy" and "Alternatives and adjuncts to moderate procedural sedation for gastrointestinal endoscopy".)
PREPROCEDURE 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 "Complications of procedural sedation for gastrointestinal endoscopy".)
The history should determine if any of the following are present:
- Significant cardiac or pulmonary disease
- Sleep apnea or snoring
- History of a difficult intubation
- Seizure or other neurologic disorder
- A prior adverse reaction to sedation or anesthesia
- Current medications
- Drug or food allergies
- Alcohol or other substance abuse
- Recent food ingestion within the past six hours or clear liquid ingestion within the past two hours
- Significant nausea and vomiting, suggesting possibility of aspiration risk
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- PREPROCEDURE 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
- POST-PROCEDURE MONITORING
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS