Anesthesia for GI endoscopy in the era of COVID-19

Abstract

As a result of COVID-19, the last few weeks have necessitated a reevaluation of the sedation paradigm for gastrointestinal (GI) endoscopic procedures. Routine screening and some surveillance procedures have taken a backseat and likely to remain so until a vaccine or effective treatment becomes available. Anesthesia providers and endoscopists are required to adapt to this new reality rapidly. The general aim of sedation remains the same-patient comfort, reduced hypoxia, prevention of aspiration along with rapid recovery, and discharge. The present review focuses on necessary modification to reduce the risk of virus contagion for both patients (from health-care providers) and vice versa. A preprocedure evaluation and consenting should be modified and provided remotely. Unsedated GI endoscopy, sedation with minimal respiratory depression, and modification of general anesthesia are explored. Challenges with supplemental oxygen administration and monitoring are addressed. Guidelines for appropriate use of personal protective equipment are discussed. Measures for limiting aerosolization are deliberated.

Up-to-date literature review and issues of sedation during digestive endoscopy.

“…There has been growing evidence that the impact of COVID-19 on sedation practices has resulted in both positive and negative effects on patient outcomes [ 6 , 7 ]. On one hand, the reduction in the use of deep sedation has been shown to decrease the risk of adverse events such as respiratory depression and aspiration and reduce the need for intensive care unit admissions [ 8 , 9 ].…”

“…Additionally, endoscopists should continue adhering to guidelines and recommendations for sedation administration, including patient monitoring and personal protective equipment. Overall, the impact of COVID-19 on sedation practices in digestive endoscopy underscores the importance of evidence-based decision-making and the need for continued research and innovation in this field [ 7 , 12 ].…”

“…While some endoscopists view the changes in sedation practices due to COVID-19 as a necessary step towards improving patient safety, others have expressed concerns about the impact of these changes on patient outcomes and the quality of endoscopic procedures. Some endoscopists argue that the reduction of the use of deep sedation has resulted in increased patient discomfort and anxiety, longer procedure times, and a reduction in endoscopist experience and skill [ 7 ]. Additionally, some endoscopists have raised concerns about the impact of the COVID-19 pandemic on patient access to endoscopic procedures, particularly for those with significant medical conditions that require sedation.…”

“…Additionally, some endoscopists have raised concerns about the impact of the COVID-19 pandemic on patient access to endoscopic procedures, particularly for those with significant medical conditions that require sedation. The reduction in the number of endoscopy procedures performed due to the pandemic has led to a backlog of patients waiting for care, which may result in delays in diagnosis and treatment for some individuals [ 7 ]. Finally, some endoscopists have expressed concerns about the impact of the COVID-19 pandemic on the financial stability of endoscopy practices, because the shift towards conscious sedation and the reduction in the number of procedures performed has resulted in decreased revenue for many practices [ 7 ].…”