Clin Endosc.  2014 Mar;47(2):135-140. 10.5946/ce.2014.47.2.135.

Sedation Regimens for Gastrointestinal Endoscopy

• Moon SH

• KMID: 2049000
• DOI: http://doi.org/10.5946/ce.2014.47.2.135

Abstract

Sedation allows patients to tolerate unpleasant endoscopic procedures by relieving anxiety, discomfort, or pain. It also reduces a patient's risk of physical injury during endoscopic procedures, while providing the endoscopist with an adequate setting for a detailed examination. Sedation is therefore considered by many endoscopists to be an essential component of gastrointestinal endoscopy. Endoscopic sedation by nonanesthesiologists is a worldwide practice and has been proven effective and safe. Moderate sedation/analgesia is generally accepted as an appropriate target for sedation by nonanesthesiologists. This focused review describes the general principles of endoscopic sedation, the detailed pharmacology of sedatives and analgesics (focused on midazolam, propofol, meperidine, and fentanyl), and the multiple regimens available for use in actual practice.

Keyword

Sedation; Endoscopy; Analgesia; Endoscopic sedation

MeSH Terms

Analgesia
Analgesics
Anxiety
Endoscopy
Endoscopy, Gastrointestinal*
Humans
Hypnotics and Sedatives
Meperidine
Midazolam
Pharmacology
Propofol
Analgesics
Hypnotics and Sedatives
Meperidine
Midazolam
Propofol

Reference

1. Cohen LB, Delegge MH, Aisenberg J, et al. AGA Institute review of endoscopic sedation. Gastroenterology. 2007; 133:675–701. PMID: 17681185.

2. Dumonceau JM, Riphaus A, Aparicio JR, et al. European Society of Gastrointestinal Endoscopy, European Society of Gastroenterology and Endoscopy Nurses and Associates, and the European Society of Anaesthesiology Guideline: non-anesthesiologist administration of propofol for GI endoscopy. Endoscopy. 2010; 42:960–974. PMID: 21072716.

3. American Society of Anesthesiologists Task Force on Sedation and Analgesia by Non-Anesthesiologists. Practice guidelines for sedation and analgesia by non-anesthesiologists. Anesthesiology. 2002; 96:1004–1017. PMID: 11964611.

4. Triantafillidis JK, Merikas E, Nikolakis D, Papalois AE. Sedation in gastrointestinal endoscopy: current issues. World J Gastroenterol. 2013; 19:463–481. PMID: 23382625.

5. Vargo JJ, Cohen LB, Rex DK, Kwo PY. Position statement: nonanesthesiologist administration of propofol for GI endoscopy. Gastrointest Endosc. 2009; 70:1053–1059. PMID: 19962497.

6. American Association for Study of Liver Diseases. American College of Gastroenterology. American Gastroenterological Association Institute. . Multisociety sedation curriculum for gastrointestinal endoscopy. Gastrointest Endosc. 2012; 76:e1–e25.

7. Rex DK, Deenadayalu VP, Eid E, et al. Endoscopist-directed administration of propofol: a worldwide safety experience. Gastroenterology. 2009; 137:1229–1237. PMID: 19549528.

8. Rex DK. Review article: moderate sedation for endoscopy: sedation regimens for non-anaesthesiologists. Aliment Pharmacol Ther. 2006; 24:163–171. PMID: 16842446.

9. Karan SB, Bailey PL. Update and review of moderate and deep sedation. Gastrointest Endosc Clin N Am. 2004; 14:289–312. PMID: 15121144.

10. Standards of Practice Committee of the American Society for Gastrointestinal Endoscopy. Lichtenstein DR, Jagannath S, et al. Sedation and anesthesia in GI endoscopy. Gastrointest Endosc. 2008; 68:815–826. PMID: 18984096.

11. Dumonceau JM, Riphaus A, Beilenhoff U, et al. European curriculum for sedation training in gastrointestinal endoscopy: position statement of the European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastroenterology and Endoscopy Nurses and Associates (ESGENA). Endoscopy. 2013; 45:496–504. PMID: 23702777.

12. Horn E, Nesbit SA. Pharmacology and pharmacokinetics of sedatives and analgesics. Gastrointest Endosc Clin N Am. 2004; 14:247–268. PMID: 15121142.

13. Vargo JJ. Anesthesia-mediated sedation for advanced endoscopic procedures and cardiopulmonary complications: of mountains and molehills. Clin Gastroenterol Hepatol. 2010; 8:103–104. PMID: 19913639.

14. Waring JP, Baron TH, Hirota WK, et al. Guidelines for conscious sedation and monitoring during gastrointestinal endoscopy. Gastrointest Endosc. 2003; 58:317–322. PMID: 14528201.

15. Riphaus A, Gstettenbauer T, Frenz MB, Wehrmann T. Quality of psychomotor recovery after propofol sedation for routine endoscopy: a randomized and controlled study. Endoscopy. 2006; 38:677–683. PMID: 16810592.

16. Laluna L, Allen ML, Dimarino AJ Jr. The comparison of midazolam and topical lidocaine spray versus the combination of midazolam, meperidine, and topical lidocaine spray to sedate patients for upper endoscopy. Gastrointest Endosc. 2001; 53:289–293. PMID: 11231385.

17. Zakko SF, Seifert HA, Gross JB. A comparison of midazolam and diazepam for conscious sedation during colonoscopy in a prospective double-blind study. Gastrointest Endosc. 1999; 49:684–689. PMID: 10343209.

18. Sipe BW, Rex DK, Latinovich D, et al. Propofol versus midazolam/meperidine for outpatient colonoscopy: administration by nurses supervised by endoscopists. Gastrointest Endosc. 2002; 55:815–825. PMID: 12024134.

19. Ulmer BJ, Hansen JJ, Overley CA, et al. Propofol versus midazolam/fentanyl for outpatient colonoscopy: administration by nurses supervised by endoscopists. Clin Gastroenterol Hepatol. 2003; 1:425–432. PMID: 15017641.

20. McQuaid KR, Laine L. A systematic review and meta-analysis of randomized, controlled trials of moderate sedation for routine endoscopic procedures. Gastrointest Endosc. 2008; 67:910–923. PMID: 18440381.

21. Byrne MF, Chiba N, Singh H, Sadowski DC. Clinical Affairs Committee of the Canadian Association of Gastroenterology. Propofol use for sedation during endoscopy in adults: a Canadian Association of Gastroenterology position statement. Can J Gastroenterol. 2008; 22:457–459. PMID: 18478130.

22. Chun SY, Kim KO, Park DS, et al. Safety and efficacy of deep sedation with propofol alone or combined with midazolam administrated by nonanesthesiologist for gastric endoscopic submucosal dissection. Gut Liver. 2012; 6:464–470. PMID: 23170151.

23. Riphaus A, Geist C, Schrader K, Martchenko K, Wehrmann T. Intermittent manually controlled versus continuous infusion of propofol for deep sedation during interventional endoscopy: a prospective randomized trial. Scand J Gastroenterol. 2012; 47:1078–1085. PMID: 22631051.

24. Lee CK, Lee SH, Chung IK, et al. Balanced propofol sedation for therapeutic GI endoscopic procedures: a prospective, randomized study. Gastrointest Endosc. 2011; 73:206–214. PMID: 21168838.

25. Lee TH, Lee CK, Park SH, et al. Balanced propofol sedation versus propofol monosedation in therapeutic pancreaticobiliary endoscopic procedures. Dig Dis Sci. 2012; 57:2113–2121. PMID: 22615018.