Sedation for gastrointestinal endoscopy

Igea, Francisco; Casellas, Juan Antonio; González-Húix, Ferrán; Gómez-Oliva, Cristina; Baudet, J; Cacho, Guillermo; Simón, Miguel Ángel; Morena, Emilio de la; Lucendo, Alfredo J.; Vida, Francesc

doi:10.1055/s-0034-1377561

Cited by 47 publications

(47 citation statements)

References 54 publications

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“…However, as a cut-off criterion for anesthesiology assistance, it remains vague. Some GI endoscopy guidelines have expressed doubts over the necessity of anesthesiology assistance in patients of ASA physical status III undergoing relatively simple procedures [2122]. …”

Section: Contentsmentioning

confidence: 99%

Practice guidelines for propofol sedation by non-anesthesiologists: the Korean Society of Anesthesiologists Task Force recommendations on propofol sedation

Kang

Kim

Choi

et al. 2016

Korean J Anesthesiol

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In South Korea, as in many other countries, propofol sedation is performed by practitioners across a broad range of specialties in our country. However, this has led to significant variation in propofol sedation practices, as shown in a series of reports by the Korean Society of Anesthesiologists (KSA). This has led the KSA to develop a set of evidence-based practical guidelines for propofol sedation by non-anesthesiologists. Here, we provide a set of recommendations for propofol sedation, with the aim of ensuring patient safety in a variety of clinical settings. The subjects of the guidelines are patients aged ≥ 18 years who were receiving diagnostic or therapeutic procedures under propofol sedation in a variety of hospital classes. The committee developed the guidelines via a de novo method, using key questions created across 10 sub-themes for data collection as well as evidence from the literature. In addition, meta-analyses were performed for three key questions. Recommendations were made based on the available evidence, and graded according to the modified Grading of Recommendations Assessment, Development and Evaluation system. Draft guidelines were scrutinized and discussed by advisory panels, and agreement was achieved via the Delphi consensus process. The guidelines contain 33 recommendations that have been endorsed by the KSA Executive Committee. These guidelines are not a legal standard of care and are not absolute requirements; rather they are recommendations that may be adopted, modified, or rejected according to clinical considerations.

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Section: Contentsmentioning

confidence: 99%

Practice guidelines for propofol sedation by non-anesthesiologists: the Korean Society of Anesthesiologists Task Force recommendations on propofol sedation

Kang

Kim

Choi

et al. 2016

Korean J Anesthesiol

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“…Propofol is becoming more commonly used as a sedative during CS, especially in western countries, due to its rapid introduction and recovery as well as high patient satisfaction [7,10,11,[19][20][21] ; however, it may cause severe cardiopulmonary suppression. Therefore, the attendance of an anesthesiologist or the use of dedicated infusion devices (such as a target controlled infuser or computer-assisted personal sedation pump) has been recommended for certain subjects [7-11, 17, 21].…”

Section: Discussionmentioning

confidence: 99%

“…In contrast, the combination of benzodiazepine and opioid is considered safe and cost-effective. Therefore, it is still the golden standard in many countries [8,9,11,12], and is also recommended in the guidelines by Japan Gastroenterological Endoscopy Society [12] and the American Gastroenterological Association [22].…”

Section: Discussionmentioning

confidence: 99%

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Risk Factor for Vital Signs Fluctuation during Colonoscopy under Conscious Sedation Consisting of Midazolam and Meperidine

Banno

Kato

Sunata

et al. 2017

Dig Dis

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Background: Sedatives or analgesics are widely used to relieve a patient’s discomfort during colonoscopy (CS). Although cardiopulmonary adverse events are sometimes experienced during the examination, the risk factors for vital signs fluctuation (VSF) have not been fully elucidated. This study thus aimed to identify the risk factors for VSF during the examination, as well as to evaluate the frequency and the degree of VSF. Summary: A total of 755 consecutive subjects who received CS under endoscopist-administrated sedation using midazolam, meperidine, or combination of both were retrospectively analyzed. We assessed the distribution of vital signs during the procedure and frequency of VSF. To identify independent risk factors, we analyzed the association between VSF and subjects’ characteristics and procedure information using the multivariate logistic regression model. Consequently, VSF was observed in 17% of all; hypotension and oxygen desaturation was observed in 13 and 5%, respectively. However, we could achieve the purpose of all procedure and, no one required hospitalization or extension of hospital stay. Multivariate analysis revealed that age (OR 1.05 [95% CI 1.04–1.07]), being female (OR 1.78 [95% CI 1.19–2.70]), and use of midazolam (OR 5.06 [95% CI 3.18–8.08]) were independent risk factors for VSF.

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“…Furthermore, during the repeated endoscopy for EVL, sedation may facilitate patient tolerance [2,3] . Midazolam has been frequently used for conscious sedation in the general population during sleep endoscopy [4,5] , and flumazenil can be used as an antidote for midazolam [6,7] .…”

Section: Introductionmentioning

confidence: 99%

Conscious Sedation Using Midazolam and Sequential Flumazenil in Cirrhotic Patients for Prophylactic Endoscopic Variceal Ligation

Kim

Jin²,

Lee³

et al. 2015

Digestion

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Background/Aims: This study investigated the safety of endoscopic variceal ligation (EVL) under conscious sedation with midazolam and sequential flumazenil after procedure in these patients. Methods: A total of 279 patients who underwent secondary prophylactic EVL at our institution between April 2012 and June 2014, were enrolled. Conscious sedation was achieved using intravenous midazolam, and flumazenil was routinely used as an antidote immediately after EVL. Patients with sleep (n = 165) and non-sleep (n = 55) endoscopy were matched using propensity score analysis (3:1). Frequencies of overt hepatic encephalopathy (HEP) and patient' satisfactions with EVL were compared between the 2 groups. Results: Of the 279 patients, 155 (55.6%) were of Child-Turcotte-Pugh (CTP) class, B or C, and 224 (80.3%) patients underwent sleep endoscopy. After propensity score analysis, overt HEP was observed in 1 (0.4%) of the 165 patients in the sedated group, but not found in any in the non-sedated group. Patient' satisfaction with EVL was better in the sedated group (p < 0.001). Twenty-nine (65.9%) of the 44 patients with CTP class C underwent sleep endoscopy, and only one (3.4%) experienced overt HEP. Conclusions: Prophylactic EVL under conscious sedation using midazolam and flumazenil is probably safe in cirrhotic patients without experience of HEP, even in those of CTP class C.

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Sedation for gastrointestinal endoscopy

Cited by 47 publications

References 54 publications

Practice guidelines for propofol sedation by non-anesthesiologists: the Korean Society of Anesthesiologists Task Force recommendations on propofol sedation

Practice guidelines for propofol sedation by non-anesthesiologists: the Korean Society of Anesthesiologists Task Force recommendations on propofol sedation

Risk Factor for Vital Signs Fluctuation during Colonoscopy under Conscious Sedation Consisting of Midazolam and Meperidine

Conscious Sedation Using Midazolam and Sequential Flumazenil in Cirrhotic Patients for Prophylactic Endoscopic Variceal Ligation

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