Recommendations for standards of sedation and patient monitoring during gastrointestinal endoscopy.

Bell, G. D.; McCloy, R F; Charlton, J. E.; Campbell, Diane; Dent, N. A.; Gear, M. W. L.; Logan, R. F. A.; Swan, Caroline

doi:10.1136/gut.32.7.823

Cited by 138 publications

(55 citation statements)

References 9 publications

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“…2.6) [3]. Recent guidelines [25] strongly suggest that the endoscopist should give the opioid drug first, and then slowly give one quarter the dose of benzodiazepine which would have been used as the sole agent. This is based on work showing that with some opioids midazolam exhibits a synergistic sedative effect [26,27], while with others the effect is at least additive [28].…”

Section: Discussionmentioning

confidence: 99%

Small bolus injections of intravenous midazolam for upper gastrointestinal endoscopy: a study of 788 consecutive cases

Smith

Bell

Quine

et al. 1993

Brit J Clinical Pharma

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Section: Discussionmentioning

confidence: 99%

Small bolus injections of intravenous midazolam for upper gastrointestinal endoscopy: a study of 788 consecutive cases

Smith

Bell

Quine

et al. 1993

Brit J Clinical Pharma

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“…Therefore, to control sedation with propofol it is essential that a person other than the one carrying out the endoscopy be present (9). For these reasons, the introduction of propofol as a substitute for benzodiazepines and opiates in endoscopy could justify an incorporation of anesthetists into these units.…”

mentioning

confidence: 99%

“…On the other hand, there are efficient antagonists such as flumazenil and naloxone that must be part of the stocks at every endoscopy unit. On other occasions, the presence of risk criteria related to sedation may determine the presence of an anesthetist (9,10).…”

mentioning

confidence: 99%

“…It has recently been demonstrated that propofol, an ultrashort-acting hypnotic agent used for the induction and maintenance of general anesthesia, is useful for the induction of deep sedation in endoscopic procedures when administered on its own or in combination with remifentanil, as it improves patient satisfaction and is associated with a lesser duration of the procedure and shorter recovery when compared to the use of midazolam-meperidine (9,10,15). In some publications, the control of deep sedation with propofol has also been shown to be safe in the hands of nonanesthetist medical staff and qualified nursing staff (16,17).…”

mentioning

confidence: 99%

“…Sedation must be understood as a continuum in which four levels may be distinguished: minimal sedation, moderate sedation (conscious sedation), deep sedation, and general anesthesia (9). Both medical and nursing staff at endoscopy units must be trained and prepared to rescue patients from sedation levels higher than originally induced, especially from ventilatory and cardiac depression, and they must have available the necessary material and human means of support (4-10).…”

mentioning

confidence: 99%

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Who should be responsible for sedation techniques in digestive endoscopy?: Reply

Vilaplana¹,

Muñoz²,

Seara³

et al. 2005

Rev. esp. enferm. dig.

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The January 2005 issue of the journal Revista Española de Enfermedades Digestivas included an original paper by J. Cubiella et al. on behalf of "Sociedad Gallega de Patología Digestiva" (SGPD) (1). The article reported the results of a study on the available sedation modalities, regular method of sedation, and sedation method desired by endoscopists at both public and private endoscopy units in Galicia. Participation in the study was 70%, and so results were considered representative for Galicia, with these being in addition comparable to those of a recent study carried out in Catalonia (2).That same issue of our Journal included an editorial by Dr. López-Timoneda and Dr. Ramírez-Armengol, from the departments of anesthesiology and endoscopy, respectively, at Hospital Clínico San Carlos in Madrid (3). Although no direct reference is made to the article by Cubiella et al., its content has raised great disquiet and unease among gastroenterology specialists in the Galician Community, as well as in SGPD itself. Statements are made on sedation in gastrointestinal endoscopy that are far from actual daily practice in our country and the international community; indeed, some of them are extremely serious, have potential medico-legal consequences, and may even raise alarm amongst the general population. In the authors' primary conclusion, they demand that "sedo-analgesia (conscious sedation) and deep sedation techniques be exclusively performed by professionals with appropriate qualifications and training for their diligent execution, which is only the case with physicians who are specialists in anesthesiology and resuscitation"; otherwise, they state that "a criminal deed of professional intrusion, as typified in Art. 403 under the criminal law in force" is committed (3).Although we must respect personal and institutional opinions that may be expressed on controversial areas in a scientific forum, those presented in the aforesaid editorial cannot be accepted as anything more than the authors' own opinion in contrast with criteria issued by scientific societies in our field. Of note, they left out recommendations by international societies of endoscopy and gastroenterology, and an attentive reading of their bibliographical references reveals that they even draw conclusion in opposition to those advocated for by their authors.Sedo-analgesia is an inseparable part of the endoscopic procedure itself. As a result, endoscopists have developed skills in administering a variety of sedative and analgesic agents to facilitate procedures and enhance patient comfort (4). Sedoanalgesia is carried out routinely in all endoscopic units under the responsibility of

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Pain Control and Sedation

Cooper¹,

Forrest

Cramp

2006

Essential Guide to Acute Care

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Recommendations for standards of sedation and patient monitoring during gastrointestinal endoscopy.

Cited by 138 publications

References 9 publications

Small bolus injections of intravenous midazolam for upper gastrointestinal endoscopy: a study of 788 consecutive cases

Small bolus injections of intravenous midazolam for upper gastrointestinal endoscopy: a study of 788 consecutive cases

Who should be responsible for sedation techniques in digestive endoscopy?: Reply

Pain Control and Sedation

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