Sedation for gastrointestinal endoscopy: The changing landscape

Current Opinion in Anaesthesiology

Volumn 20, Issue 4, 2007, Pages 359-364

  Trummel, John ^a  

^a DARTMOUTH HITCHCOCK MEDICAL CENTER   (United States)

Author keywords

Gastrointestinal endoscopy; Nonoperating room anesthesia; Propofol; Sedation

Indexed keywords

DEXMEDETOMIDINE; DIPHENHYDRAMINE; FENTANYL; INFUSION FLUID; MIDAZOLAM; PETHIDINE; PROPOFOL; REMIFENTANIL;

ANESTHESIST; CONTINUOUS INFUSION; CONVALESCENCE; DRUG CHOICE; DRUG COST; ENDOSCOPIC ECHOGRAPHY; ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY; ENDOSCOPIC SURGERY; GASTRODUODENOSTOMY; GASTROINTESTINAL ENDOSCOPY; HEALTH ECONOMICS; HEMODYNAMICS; HUMAN; HYPOTENSION; LOW DRUG DOSE; MEDICAL LITERATURE; NURSE TRAINING; PATIENT SAFETY; PRIORITY JOURNAL; PSYCHOMOTOR PERFORMANCE; RESPIRATION DEPRESSION; RESPIRATORY DISTRESS; REVIEW; SEDATION; SIDE EFFECT;

CONSCIOUS SEDATION; DRUG DELIVERY SYSTEMS; ENDOSCOPY, GASTROINTESTINAL; EUROPE; HUMANS; HYPNOTICS AND SEDATIVES; MONITORING, PHYSIOLOGIC; PROPOFOL; UNITED STATES;

EID: 34447338591     PISSN: 09527907     EISSN: None     Source Type: Journal    
DOI: 10.1097/ACO.0b013e32827ab467     Document Type: Review

References (31)

1. Freeman ML. Sedation and monitoring for gastrointestinal endoscopy. In: Yamada T, editor. Textbook of Gastroenterology, 4th edition Philadelphia: Lippincott, Williams & Wilkins; 2003. pp. 2818-2820.
2. American Society of Anesthesiologists. Continuum of depth of sedation: definition of general anesthesia and levels of sedation/analgesia. Approved by ASA House of Delegates on October 13, 1999, and amended on October 27, 2004. Available at: http://www.asahq.org/publicationsAndServices/ standards/20.pdf. [Last accessed April 2, 2007]
3. Zuccaro G Jr. Sedation and analgesia for GI endoscopy. Gastrointest Endosc 2006; 63:95-96.
4. Rex DK. The science and politics of propofol. Am J Gastroenterol 2004; 99:2080-2083.
5. American Society of Anesthesiologists. Statement on granting privileges to nonanesthesiologist practitioners for personally administering deep sedation or supervising deep sedation by individuals who are not anesthesia professionals. Approved by the ASA House of Delegates on October 18, 2006. Available at: http://www.asahq.org/publicationsAndServices/standards/ 39.pdf. [Last accessed April 2, 2007]
6. American College of Gastroenterology. Three gastroenterology specialty groups issue joint statement on sedation in endoscopy: a joint statement of a working roup from the American College of Gastroenterology, the American Gastroenterological Association and the American Society for Gastrointestinal Endoscopy. March 8, 2004. Available at: http://www.gi.org/physicians/ nataffairs/trisociety.asp. [Last accessed March 15, 2007]
7. Cohen LB, Wecsler JS, Gaetano JN, et al. Endoscopic sedation in the United States: results from a nationwide survey. Am J Gastroenterol 2006; 101: 967-974. This survey provides a broad up-to-date overview of the scope of endoscopic sedation practice in the US.
8. Froelich F, Harris JK, Wietlisbach V, et al. Current sedation and monitoring practice for colonoscopy: an International Observational Study (EPAGE). Endoscopy 2006; 38:461-469. An observational study that provides interesting data, broken down by depth of sedation, although there is likely significant reporting bias.
9. Cohen LB, Wecsler JS, Gaetano JN, et al. Endoscopic sedation in the United States: results from a nationwide survey. Am J Gastroenterol 2006; 101:967-974.
10. Aisenberg J, Brill JV, Ladabaum U, Cohen LB. Sedation for gastrointestinal endoscopy: new practices, new economics. Am J Gastroenterol 2005; 100:996-1000.
11. Rex DK, Overly CW, Walker J. Registered nurse-administered propofol sedation for upper endoscopy and colonosocopy: Why? When? How? Rev Gastroenterol Disord 2003; 3:70-80.
12. Rex DK, Heuss LT, Walker JA, Rong Qi. Trained registered nurses/endoscopy teams can administer propofol safely for endoscopy. Gastroenterology 2005; 129:1384-1391.
13. Tohda G, Higashi S, Wakahara S, et al. Propofol sedation during endoscopic procedures: safe and effective administration by registered nurses supervised by endoscopists. Endoscopy 2006; 38:360-367. This study on NAPS involves a large number of patients; incredibly, the authors reported no airway interventions in any patient.
14. VanNatta ME, Rex DK. Propofol alone titrated to deep sedation versus propofol in combination with opioids and/or benzodiazepines and titrated to moderate sedation for colonoscopy. Am J Gastroenterol 2006; 101:2209-2217. The major finding of this study - that combination therapy can successfully be used to provide moderate sedation for endoscopy - is intriguing. Further examination of this finding would be useful.
15. Brown BJ, Richardson C, Stoll CE, et al. Airway interventions during propofol sedation. Anesthesiology 2006; 105:A1584.
16. Stonell CA, Leslie K, Absalom AR. Effect-site targeted patient-controlled sedation with propofol: comparison with anaesthetist administration for colonoscopy. Anaesthesia 2006; 61:240-247. A small study of PCS and provides a good, brief review of the topic.
17. Mandel JE, Tanner J, Lichtenstein G, et al. Patient-controlled sedation for colonoscopy with propofol/remifentanil vs. midazolam/fentanyl. Anesthesiology 2006; 105:A570.
18. Moerman AT, Pambianco D, McRorie J, et al. Feasibility assessment of a sedation delivery system to administer propofol for GI endoscopy. Anesthesiology 2006; 105:A1586.
19. Sieg A, Hachmoeller-Eisenbach U, Eisenbach T. Prospective evaluation of complications in outpatient GI endoscopy: a survey among German gastroenterologists. Gastrointest Endosc 2001; 53:620-627.
20. Bhananker SM, Posner KL, Cheney FW, et al. Injury and liability associated with monitored anesthesia care. Anesthesiology 2006; 104:228-234. While not specifically reviewed in this article, this study should be required reading for anyone involved in monitored anesthesia care (MAC). It provides an understanding of some of the high risk situations encountered in nonoperating room anesthesia.
21. Trummel JM, Surgenor SD, Blike GT, et al. Comparison of the quality of procedural sedation for upper endoscopic ultrasound in adults. Anesthesiology 2006; 105:A1395.
22. Jalowiecki P, Rudner R, Gonciarz M, et al. Sole use of dexmedetomidine has limited utility for conscious sedation during outpatient colonoscopy. Anesthesiology 2005; 103:269-273.
23. Moerman AT, Foubert LA, Herregods LL, et al. Propofol versus remifentanil for monitored anaesthesia care during colonoscopy. Eur J Anaesth 2003; 20:461-466.
24. Akcaboy ZN, Akcaboy EY, Albayrak D, et al. Can Remifentanil be a better choice than propofol for colonoscopy during monitored anesthesia care? Act Anaesthesiol Scand 2006; 50:736-741. This study indicates that low-dose remifentanil can be used in endoscopy effectively, although the study is small.
25. Hirsch I, Vaissler A, Chernin J, et al. Fentanyl or Tramadol, with midazolam, for outpatient colonoscopy: analgesia, sedation, and safety. Dig Dis Sci 2006; 51:1946-1951.
26. Tu RH, Grewall P, Leung JW, et al. Diphenhydramine as an adjunct to sedation for colonoscopy: a double-blind randomized, placebo-controlled study. Gastrointest Endosc 2006; 63:87-94.
27. VanNatta ME, Rex DK. Propofol alone titrated to deep sedation versus propofol in combination with opioids and/or benzodiazepines and titrated to moderate sedation for colonoscopy. Am J Gastroenterol 2006; 101: 2209-2217.
28. Bhananker SM, Posner KL, Cheney FW, et al. Injury and liability associated with monitored anesthesia care. Anesthesiology 2006; 104:228-234.
29. Leslie K, Tay T, Neo E. Intravenous fluid to prevent hypotension in patients undergoing elective colonoscopy. Anaesth Intensive Care 2006; 34:316-321.
30. Riphaus A, Gstettenbauer T, Frenz WB, Wehrmann T. Quality of psychomotor recovery after propofol sedation for routine endoscopy: a randomized and controlled study. Endoscopy 2006; 38:677-683.
31. Patel S, Vargo JJ, Khandwala F, et al. Deep sedation occurs frequently during elective endoscopy with meperidine and midazolam. Am J Gastroenterol 2005; 100:2689-2695.