Alternatives and adjuncts to moderate 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 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 propofolTo continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- PATIENTS WHO ARE LIKELY TO BE DIFFICULT TO SEDATE
- ADJUNCTS TO MODERATE PROCEDURAL SEDATION
- Other drugs
- DEEP PROCEDURAL SEDATION
- Patient monitoring during deep sedation
- - Capnography
- - Bispectral (BIS) monitoring
- - Efficacy of propofol
- Upper endoscopy and colonoscopy
- Advanced procedures
- - Potential adverse effects
- - Propofol administration techniques
- Standard techniques
- Patient-controlled sedation
- - Administration by non-anesthesiologists
- GENERAL ANESTHESIA
- Settings in which general anesthesia is used
- Airway assessment
- Laryngeal mask airway
- SUMMARY AND RECOMMENDATIONS