Procedural sedation

Current Opinion in Gastroenterology
John J Vargo

Abstract

To encapsulate the recent developments in endoscopic procedural sedation from the standpoints of safety, efficacy and policy. Initial studies addressing the presence of obstructive sleep apnea in patients undergoing upper endoscopy and colonoscopy did not find an increased risk of cardiopulmonary complications. A worldwide study of 646 080 patients receiving endoscopist-directed propofol sedation found a mortality rate of one per 161 515 cases, which all occurred in patients with high-risk comorbidities. The incidence of bag mask ventilation was significantly higher for upper endoscopy when compared to colonoscopy (185/185 245; 0.1% vs. 20/142 863, 0.01%; P<0.001). The presence of obstructive sleep apnea whether diagnosed by a surrogate validated questionnaire to by the gold standard sleep study does not appear to lead to increased rates of hypoxemia in patients undergoing ambulatory upper endoscopy. Endoscopist-directed propofol sedation is well tolerated in the appropriately selected patient. The use of anesthesia-assisted sedation for American Society of Anesthesiologists class I and II patients for upper endoscopy and colonoscopy is cost-ineffective.

References

Nov 18, 1988·JAMA : the Journal of the American Medical Association·M M CohenR B Tate
Jul 16, 2003·Acta Anaesthesiologica Scandinavica·Y KawashimaT Kugimiya
Nov 5, 2003·Gastrointestinal Endoscopy·Lawrence B CohenKenneth M Miller
Jun 18, 2005·Anaesthesia·G J McHugh
Oct 21, 2005·Anaesthesia and Intensive Care·N Gibbs, P Rodoreda
Jun 27, 2007·Gastrointestinal Endoscopy·Virender K SharmaDavid E Fleischer
Jun 25, 2009·Gastroenterology·Douglas K RexNizam Meah
Jul 18, 2009·Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association·Gregory A CotéSreenivasa S Jonnalagadda
Aug 8, 2009·Gastrointestinal Endoscopy·Vijay S KhianiAmitabh Chak
Dec 8, 2009·Gastroenterology·John J VargoUNKNOWN American Society for Gastrointestinal Endoscopy

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Citations

Jan 10, 2012·Air Medical Journal·Richard Chalwin
Jul 14, 2011·Nature Reviews. Gastroenterology & Hepatology·Michaela Müller, Till Wehrmann
Jan 15, 2013·Anesthesiology·Michael A FrölichTimothy J Ness

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