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Alternatives and adjuncts to moderate procedural sedation for gastrointestinal endoscopy

Author
Jonathan Cohen, MD
Section Editors
John R Saltzman, MD, FACP, FACG, FASGE, AGAF
Girish P Joshi, MB, BS, MD, FFARCSI
Deputy Editor
Kristen M Robson, MD, MBA, FACG

INTRODUCTION

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.

Most of the attention has been placed on selecting the optimal regimen for producing procedural sedation and monitoring patients adequately during the procedures. Many procedures are performed using intravenous benzodiazepines and opiates (previously referred to as intravenous conscious sedation), which typically result in moderate degrees of sedation. There have been attempts to determine which patients and procedures require deeper sedation. In addition, there has been an effort to make some diagnostic procedures more tolerable to avoid the cost and risk of procedural sedation altogether.

Endoscopists occasionally encounter individuals who are difficult to adequately sedate for endoscopy using standard agents. In addition, certain therapeutic endoscopic procedures require deeper levels of sedation. There are multiple options in these settings:

Addition of diphenhydramine to standard procedural sedation

Administration of propofol

                      
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Literature review current through: Nov 2017. | This topic last updated: Dec 04, 2017.
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