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Anesthesia for gastrointestinal endoscopy in adults

Basavana Goudra, MD, FRCA, FCARCSI
Section Editor
Girish P Joshi, MB, BS, MD, FFARCSI
Deputy Editor
Marianna Crowley, MD


There has been a rapid increase in the number and complexity of gastrointestinal (GI) endoscopic procedures performed during the last decade [1]. Anesthesiologists may be asked to provide anesthesia for procedures that require sedation or general anesthesia, or to provide monitoring with or without sedation for patients with significant comorbidities. The complexity of endoscopic procedures has increased, and advanced endoscopic procedures are often performed as alternatives to open surgery for medically complicated patients.  

This topic will discuss anesthetic management for gastrointestinal endoscopy. Management of monitored anesthesia care, office based anesthesia, and procedural sedation and alternatives to sedation administered by non-anesthesia clinicians are discussed separately. (See "Monitored anesthesia care in adults" and "Overview of procedural sedation for gastrointestinal endoscopy" and "Alternatives and adjuncts to moderate procedural sedation for gastrointestinal endoscopy" and "Sedation-free gastrointestinal endoscopy" and "Office-based anesthesia".)


A medical history and anesthesia-directed physical examination should be performed for all patients who undergo any type of anesthesia, including sedation for endoscopy. The goals for preanesthesia evaluation are to identify underlying medical and physical conditions that may increase risk and to create an anesthetic plan that minimizes risk.

In anticipation of gastrointestinal endoscopy, the patient should be evaluated for conditions that increase sensitivity to sedative and analgesic medications (eg, older age; obstructive sleep apnea; advanced chronic lung disease; pulmonary hypertension; coronary artery, liver, or renal disease; anxiety disorders; chronic pain; use of opioids, sedatives, or recreational drugs) to allow appropriate drug dosing and administration. (See "Overview of procedural sedation for gastrointestinal endoscopy", section on 'Patient-related considerations'.)

ASA physical status — Similar to other procedures that require anesthesia, patients with higher American Society of Anesthesiologists (ASA) physical status (table 1) classification are at increased risk of periprocedural adverse events [2,3]. The complexity and application of advanced endoscopic procedures are increasing, as well as the comorbidities of the patients who undergo these procedures. In particular, therapeutic endoscopic retrograde cholangiopancreatography (ERCP) is associated with increased risk of adverse events, regardless of ASA status [2], and is now performed for patients who were previously considered inoperable or who are critically ill.

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Literature review current through: Oct 2017. | This topic last updated: Oct 16, 2017.
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  1. Goudra BG, Singh PM, Penugonda LC, et al. Significantly reduced hypoxemic events in morbidly obese patients undergoing gastrointestinal endoscopy: Predictors and practice effect. J Anaesthesiol Clin Pharmacol 2014; 30:71.
  2. Enestvedt BK, Eisen GM, Holub J, Lieberman DA. Is the American Society of Anesthesiologists classification useful in risk stratification for endoscopic procedures? Gastrointest Endosc 2013; 77:464.
  3. Sharma VK, Nguyen CC, Crowell MD, et al. A national study of cardiopulmonary unplanned events after GI endoscopy. Gastrointest Endosc 2007; 66:27.
  4. Goudra B, Singh PM, Gouda G, et al. Propofol and non-propofol based sedation for outpatient colonoscopy-prospective comparison of depth of sedation using an EEG based SEDLine monitor. J Clin Monit Comput 2016; 30:551.
  5. Soto RG, Fu ES, Vila H Jr, Miguel RV. Capnography accurately detects apnea during monitored anesthesia care. Anesth Analg 2004; 99:379.
  6. Srinivasa V, Kodali BS. Capnometry in the spontaneously breathing patient. Curr Opin Anaesthesiol 2004; 17:517.
  7. Bhananker SM, Posner KL, Cheney FW, et al. Injury and liability associated with monitored anesthesia care: a closed claims analysis. Anesthesiology 2006; 104:228.
  8. Goudra B, Singh PM. ERCP: the unresolved question of endotracheal intubation. Dig Dis Sci 2014; 59:513.
  9. Goudra BG, Singh PM, Sinha AC. Outpatient endoscopic retrograde cholangiopancreatography: Safety and efficacy of anesthetic management with a natural airway in 653 consecutive procedures. Saudi J Anaesth 2013; 7:259.
  10. Goudra B, Singh PM, Gouda G, Sinha AC. Peroral endoscopic myotomy-initial experience with anesthetic management of 24 procedures and systematic review. Anesth Essays Res 2016; 10:297.
  11. Padmanabhan A, Frangopoulos C, Shaffer LET. Patient Satisfaction With Propofol for Outpatient Colonoscopy: A Prospective, Randomized, Double-Blind Study. Dis Colon Rectum 2017; 60:1102.
  12. Vuyk J. TCI: supplementation and drug interactions. Anaesthesia 1998; 53 Suppl 1:35.
  13. Vuyk J. Pharmacokinetic and pharmacodynamic interactions between opioids and propofol. J Clin Anesth 1997; 9:23S.
  14. Haytural C, Aydınlı B, Demir B, et al. Comparison of Propofol, Propofol-Remifentanil, and Propofol-Fentanyl Administrations with Each Other Used for the Sedation of Patients to Undergo ERCP. Biomed Res Int 2015; 2015:465465.
  15. Smith MR, Bell GD, Quine MA, et al. Small bolus injections of intravenous midazolam for upper gastrointestinal endoscopy: a study of 788 consecutive cases. Br J Clin Pharmacol 1993; 36:573.
  16. Cohen LB, Wecsler JS, Gaetano JN, et al. Endoscopic sedation in the United States: results from a nationwide survey. Am J Gastroenterol 2006; 101:967.
  17. Faulx AL, Vela S, Das A, et al. The changing landscape of practice patterns regarding unsedated endoscopy and propofol use: a national Web survey. Gastrointest Endosc 2005; 62:9.
  18. Goudra BG, Singh PM, Sinha AC. Anesthesia for ERCP: Impact of Anesthesiologist's Experience on Outcome and Cost. Anesthesiol Res Pract 2013; 2013:570518.
  19. Manolaraki MM, Theodoropoulou A, Stroumpos C, et al. Remifentanil compared with midazolam and pethidine sedation during colonoscopy: a prospective, randomized study. Dig Dis Sci 2008; 53:34.
  20. Demiraran Y, Korkut E, Tamer A, et al. The comparison of dexmedetomidine and midazolam used for sedation of patients during upper endoscopy: A prospective, randomized study. Can J Gastroenterol 2007; 21:25.
  21. Jalowiecki P, Rudner R, Gonciarz M, et al. Sole use of dexmedetomidine has limited utility for conscious sedation during outpatient colonoscopy. Anesthesiology 2005; 103:269.
  22. Dere K, Sucullu I, Budak ET, et al. A comparison of dexmedetomidine versus midazolam for sedation, pain and hemodynamic control, during colonoscopy under conscious sedation. Eur J Anaesthesiol 2010; 27:648.
  23. Muller S, Borowics SM, Fortis EA, et al. Clinical efficacy of dexmedetomidine alone is less than propofol for conscious sedation during ERCP. Gastrointest Endosc 2008; 67:651.
  24. Akhondzadeh R, Ghomeishi A, Nesioonpour S, Nourizade S. A comparison between the effects of propofol-fentanyl with propofol-ketamine for sedation in patients undergoing endoscopic retrograde cholangiopancreatography outside the operating room. Biomed J 2016; 39:145.
  25. Goyal R, Hasnain S, Mittal S, Shreevastava S. A randomized, controlled trial to compare the efficacy and safety profile of a dexmedetomidine-ketamine combination with a propofol-fentanyl combination for ERCP. Gastrointest Endosc 2016; 83:928.
  26. Metzner J, Posner KL, Domino KB. The risk and safety of anesthesia at remote locations: the US closed claims analysis. Curr Opin Anaesthesiol 2009; 22:502.
  27. Goudra B, Nuzat A, Singh PM, et al. Association between Type of Sedation and the Adverse Events Associated with Gastrointestinal Endoscopy: An Analysis of 5 Years' Data from a Tertiary Center in the USA. Clin Endosc 2017; 50:161.
  28. Goudra B, Nuzat A, Singh PM, et al. Cardiac arrests in patients undergoing gastrointestinal endoscopy: A retrospective analysis of 73,029 procedures. Saudi J Gastroenterol 2015; 21:400.
  29. Wernli KJ, Brenner AT, Rutter CM, Inadomi JM. Risks Associated With Anesthesia Services During Colonoscopy. Gastroenterology 2016; 150:888.
  30. Leslie K, Allen ML, Hessian EC, et al. Safety of sedation for gastrointestinal endoscopy in a group of university-affiliated hospitals: a prospective cohort study. Br J Anaesth 2017; 118:90.