Adverse events during monitored anesthesia care for GI endoscopy: an 8-year experience

Safety and Prevention of Complications in Endoscopic Sedation

“…The low incidence of complications may be attributed to new technologies such as computer-assisted personalized sedation. Additionally, high levels of monitoring may standardize the use of propofol by non-anesthesiologists in endoscopy [22][23][24][25]. The American College of Gastroenterology and the American Society for Gastrointestinal Endoscopy have published a joint statement supporting the safe use of non-anesthesiologist-administered propofol for GI endoscopy [26].…”

“…They also found that ASA scores of 3 or higher were predictors of complications. An Italian study recently described a sample of 17,542 patients sedated by Monitored Anesthesia Care (MAC) during endoscopy and predicted the occurrence of any complication using six variables that were screened for age (1- [22].…”

“…First, Chafic et al [30] did not include many patients who underwent advanced endoscopic procedures such as ERCP, EUS, and endoscopic submucosal dissection (ESD) and did not assess the relationships between ASA scores and complication rates. High ASA scores and longer procedure times have been suggested to be important predictors of the occurrence of complications during sedation for endoscopy [22,27,28]. As Rex et al [20] suggested, anesthesiologist-administered MAC may be preferred over gastroenterologist-administered sedation for patients with an ASA score higher than 2.…”

A Much Sought-After Drug—Propofol Sedation for GI Endoscopy: Always Better but Who Cares?

“…In recent years, propofol has been safely and effectively used in advanced interventional endoscopic procedures, such as ERCP and EUS, even for high-risk patients [1]. Propofol is a hypnotic drug with rapid onset and offset of action.…”

“…The American Society of Anesthesiologists (ASA) guidelines recommend accurate titration of sedative/analgesic drugs to improve patient's comfort and safety, with the specific recommendation to limit the risk of oversedation. Among the different methods now available for propofol administration, TCI is undoubtedly one of the most sophisticated and propofol TCI has proved to be an excellent and safe procedure during sedation for endoscopic procedures [1]. Technological developments are rapidly advancing with the advent of computer-assisted personalized propofol administration systems (such as the SEDASYS TM (Ethicon Endo-Surgery, Cincinnati, OH), which effectively assist physician-nurse teams to maintain minimal-to-moderate sedation levels throughout GI endoscopy, thereby limiting the risk of inadvertent deep sedation and its mostly feared consequence, cardio-respiratory failure [6].…”