Sedation/Analgesia Administration Practice Varies according to Endoscopy Facility (Hospital- or Office-Based) Setting: Results from a Nationwide Survey in Greece

Abstract

Objectives. To examine the impact of endoscopy setting (hospital-based vs. office-based) on sedation/analgesia administration and to provide nationwide data on monitoring practices among Greek gastroenterologists in real-world settings. Material and Methods. A web-based survey regarding sedation/analgesia rates and monitoring practices during endoscopy either in a hospital-based or in an office-based setting was disseminated to the members of the Hellenic Society of Gastroenterology and Professional Association of Gastroenterologists. Participants were asked to complete a questionnaire, which consisted of 35 items, stratified into 4 sections: demographics, preprocedure (informed consent, initial patient evaluation), intraprocedure (monitoring practices, sedative agents’ administration rate), and postprocedure practices (recovery). Results. 211 individuals responded (response rate: 40.3%). Propofol use was significantly higher in the private hospital compared to the public hospital and the office-based setting for esophagogastroduodenoscopy (EGD) (85.8% vs. 19.5% vs. 10.5%, p<0.0001) and colonoscopy (88.2% vs. 20.1% vs. 9.4%, p<0.0001). This effect was not detected for midazolam, pethidine, and fentanyl use. Endoscopists themselves administered the medications in most cases. However, a significant contribution of anesthesiology sedation/analgesia provision was detected in private hospitals (14.7% vs. 2.8% vs. 2.4%, p<0.001) compared to the other settings. Only 35.2% of the private offices have a separate recovery room, compared to 80.4% and 58.7% of the private hospital- and public hospital-based facilities, respectively, while the nursing personnel monitored patients’ recovery in most of the cases. Participants were familiar with airway management techniques (83.9% with bag valve mask and 23.2% with endotracheal intubation), while 49.7% and 21.8% had received Basic Life Support (BLS) and Advanced Life Support (ALS) training, respectively. Conclusion. The private hospital-based setting is associated with higher propofol sedation administration both for EGD and for colonoscopy. Greek endoscopists are adequately trained in airway management techniques.

Sedation during endoscopic procedures: a Hellenic Society of Gastroenterology Position Statement

“…This level depends on the type of the endoscopic examination, the expected duration, and the patient’s age and general condition as evaluated prior to the procedure (ASA classification) [ 27 ]. Finally, the antagonists are used to reverse the action of the main drug(s) and for quicker and safer recovery after the examination, or for improvement of the level of consciousness, if necessary, during the endoscopic procedure [ 30 , 31 ].…”

“…Midazolam is commonly used for this purpose, as it does not cause hypotension or hypoxia in regular doses, exhibits a rather short half-life and has a sedative effect that can be reversed by flumazenil [ 6 , 31 , 4 , 73 ]. During the past few years, there has been increasing interest in a new generation benzodiazepine, remimazolam, due to the rapid onset and “deterioration” of its sedative effect along with a more favorable safety profile: remimazolam is not associated with cardiovascular or respiratory suppression, even in older patients or those with ASA >III [ 74 , 30 ].…”

“…Regarding the use of dexmedetomidine or ketamine for sedation during urgent endoscopy, although the data appear encouraging, no safe conclusions can be drawn as there is a lack of sufficient evidence [ 30 , 78 ]. The lack of experience and familiarity of gastroenterologists nationwide with the use of both sedatives further discourages their use at this point.…”