2021 Korean Society of Gastrointestinal Endoscopy Clinical Practice Guidelines for Endoscopic Sedation

Abstract

Sedation can resolve anxiety and fear in patients undergoing endoscopy. The use of sedatives has increased in Korea. Appropriate sedation is a state in which the patient feels subjectively comfortable while maintaining the airway reflex for stable spontaneous breathing. The patient should maintain a state of consciousness to the extent that he or she can cooperate with the needs of the medical staff. Despite its benefits, endoscopic sedation has been associated with cardiopulmonary complications. Cardiopulmonary complications are usually temporary. Most patients recover without sequelae. However, they may progress to serious complications, such as cardiovascular collapse. Therefore, it is essential to screen high-risk patients before sedation and reduce complications by meticulous monitoring. Additionally, physicians should be familiar with the management of emergencies. The first Korean clinical practice guideline for endoscopic sedation was developed based on previous worldwide guidelines for endoscopic sedation using an adaptation process. The guideline consists of nine recommendations based on a critical review of currently available data and expert consensus when the guideline was drafted. These guidelines should provide clinicians, nurses, medical school students, and policy makers with information on how to perform endoscopic sedation with minimal risk. Clin Endosc 2022 Feb 22. [Epub ahead of print]

Development of a predictive model for hypoxia due to sedatives in gastrointestinal endoscopy: a prospective clinical study in Korea

“…Recently, interest in personal health has been increasing in the Korean population, and the number of endoscopy examinations has been steadily increasing due to their use in screening tests for gastric cancer and colorectal cancer in this country, and the number of sedative endoscopy cases is also increasing. 8 Sedation is widely used for endoscopic procedures worldwide to reduce patient anxiety and discomfort, consequently improving their tolerability and satisfaction with the procedure. 1 Endoscopic sedation also allows endoscopists to perform endoscopy more efficiently and has improved the quality of the examination.…”

“…Based on the Korean clinical practice guidelines for endoscopic sedation, the initial dose of sedative agents was determined by the age and weight of the patient, as well as the recommendation of the endoscopist. 8 Additional doses were titrated based on the assessment of patient tolerance by the endoscopist. All patients were monitored by using continuous electrocardiography, heart rate, pulse oximetry, and non-invasive blood pressure monitoring at 5-minute intervals during the procedure.…”

Anesthesia care provider sedation versus conscious sedation for endoscopic ultrasound–guided tissue acquisition: a retrospective cohort study

“… 18 In the present study, given that the majority of patients were not considered high-risk as they were primarily ASA class I-III, the risks associated with endotracheal intubation and GA likely outweighed the benefit in this group, thus contributing to more AEs and identifying intubation as a main predictor for these AEs. Although there are guidelines outlining the qualifications required to provide sedation, 19 there is little consensus or guidelines explicitly identifying who the preferred provider should be, whether it is an anesthesia provider or endoscopist. 20 Given the increased use of anesthesia professionals for endoscopic procedures, 21 further study is required to better understand which patients and procedure types require anesthesia and strategies to minimize the risks of AEs for endoscopic procedures performed by ACPs.…”

Prevention and management of sedative complications

“…3 In Korea, the Korean Society of Gastrointestinal Endoscopy (KSGE) released sedation during endoscopy guidelines in 2022. 4 In this lecture, we will focus on these domestic and international guidelines and examine the prevention of adverse events, patient monitoring, and management of adverse events for safe sedation during endoscopy.…”