Sedation for upper gastrointestinal endoscopy: results of a nationwide survey.

Abstract

A postal questionnaire inquiring about routine sedation and premedication practice for upper gastrointestinal endoscopy was sent to 1048 doctors. Of 665 appropriate returns, 81% were from consultant physicians and surgeons. Most endoscopists (90%) reported using an intravenous benzodiazepine for at least three quarters of endoscopies and 54% of physicians and 69% of surgeons always did so. Midazolam was the intravenous sedative used by a third of ali respondents and 13% also used an additional intravenous agent, usualiy pethidine. Over the previous two years a total of 119 respiratory arrests, 37 cardiac arrests, and 52 deaths were identified. Adverse outcomes were reported more frequently by consultant physicians, by those who 'titrated' the intravenous sedative, and by those who used an additional intravenous agent, but were reported equaliy frequently by endoscopists using midazolam and endoscopists using diazepam. There is an urgent need for a prospective study to identify the circumstances and risk factors associated with adverse outcomes related to endoscopy.

Safety and Prevention of Complications in Endoscopic Sedation

“…The four deaths in this large cohort of patients occurred in patients with American Society of Anesthesiologists (ASA) [21] statuses of 3 or higher who were undergoing non-routine medical procedures, and three of the patients had serious underlying illnesses. These results indicate that the safety of propofol administration by endoscopists is comparable or superior to the published safety records of opioids and benzodiazepines administered by endoscopists for GI endoscopy [5][6][7][8]. The low incidence of complications may be attributed to new technologies such as computer-assisted personalized sedation.…”

“…The incidence of adverse events for these standard sedatives is very low [2,[5][6][7][8]. For instance, a large-scale retrospective study (21,011 patients) of midazolam for endoscopic sedation showed that the complication rate was only 1.35 % [2].…”

Meta-analysis of capsule endoscopy in patients diagnosed or suspected with esophageal varices

“…However, the procedure is unpleasant, and still associated with a small but potential risk of complications [5] . In addition, it is often carried out with the patients under sedation, which may bring additional complications in patients with cirrhosis [6] .…”

Austrian Society of Gastroenterology and Hepatology (ÖGGH) - Guidelines on sedation and monitoring during gastrointestinal endoscopy

“…The risk of the examina− tion or intervention depends primarily on the in− vasiveness and technical complexity of the pro− cedure, but also on the patient's individual risk profile and the specific side−effect profile of the sedatives or anesthetics used. The overall rate of serious complications in gastroenterological ex− aminations and interventions is between 1 in 1000 and 1 in 7500 [2]. The quality of procedures and, in turn, patient safety depend greatly on precise and careful risk estimation before, during, and after the proce− dure.…”