Sedation Related to Gastrointestinal Endoscopy

In the last ten years the number of worldwide gastrointestinal endoscopic procedures has significantly increased; the majority are ambulatory endoscopies with appropriate intravenous sedation and analgesia which seems to be used more and more frequent. By definition, sedation is a drug-induced depression in the level of consciousness. Moderate sedation current terminology replaces the previous terminology called conscious sedation (American Society of Anesthesiologists [ASA], 2002). Sedation and analgesia are being used in order to improve patient tolerance to endoscopic procedures by diminishing anxiety and discomfort. There are several sequent benefits: an adequate sedation allows the endoscopist to focus on the technical performance of the endoscopy, increases the rate of patients returning for follow-up examinations or for colonoscopic screening, prevents potentially harmful autonomic stress responses and improves the public reputation of the procedure. However, these benefits must be weighed against the complications (especially in the form of potential compromise of ventilatory function) and the added cost associated with the use of sedation and analgesia. Patients with associated comorbidities address to the gastroscopist to perform an endoscopy without being evaluated for their pathologies that could influence the procedures used in sedation. In addition, in cases where the examination is more invasive or conducted in a larger time interval, the level of sedation should be optimized to achieve an ideal procedure (ASA, 2002; Faigel et al., 2002). The practice of sedation varies from country to country, determined by cultural differences in pain perception and expectations of patients and physicians. A recent international study of 21 centers in 10 European countries and in Canada reported that the use of sedation during endoscopy varies from 0% to 100% at different sites: it was used in 44% of all procedures in Asia, 56% in Europe, and 72% in Canada, Central America and South Latin America. In the United States, only flexible sigmoidoscopy is performed without sedation (Wang&Lin, 1999). Such diversity reflects social, cultural, regulatory and economic consideration. Best practices for analgesia and sedation during gastrointestinal endoscopy are still debated. Ensuring an adequate sedation and analgesia influences some aspects of endoscopic procedures such as quality of examination, patient cooperation, patient and performing physician satisfaction (Bell, 2004). There are several practical issues with implications for endoscopic sedation (Thomson et al., 2010):

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