What is it about?
Sedation practices for gastrointestinal endoscopic (GIE) procedures vary widely in different countries depending on health system regulations and local circumstances. The goal of procedural sedation is the safe and effective control of pain and anxiety, as well as to provide an appropriate degree of memory loss or decreased awareness. Sedation-related complications in gastrointestinal endoscopy, once occurred, can lead to significant morbidity and occasional mortality in patients. The risk factors of these complications include the type, dose and mode of administration of sedative agents, as well as the patient’s age and underlying medical diseases.
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Why is it important?
Complications attributed to moderate and deep sedation levels are more often associated with cardiovascular and respiratory systems. However, sedation-related complications during GIE procedures are commonly transient and of a mild degree. The risk for these complications while providing any level of sedation is greatest when caring for patients already medically compromised. Significant unwanted complications can generally be prevented by careful pre-procedure assessment and preparation, appropriate monitoring and support, as well as post-procedure management. Additionally, physicians must be prepared to manage these complications. This article will review sedation-related complications during moderate and deep sedation for GIE procedures and also address their appropriate management.
Perspectives
Sedation-related complications are relatively common. However, the majority of these complications are transient and easily treated. Serious complications are rare for GIE procedural sedation. Sedation-related complications may be severe if physicians do not detect and treat patients earlier. Appropriate pre-sedation assessment and proper patient selection, preparation and optimization of patients, as well as the availability of skilled professionals for sedation administration are key components to provision of quality patient care. Periodical assessment of the level of sedation and continuous monitoring of cardiovascular and respiratory systems provides timely information. Pulse oximetry and oxygen supplementation are recommended for the reduction of hypoxemia. Capnography monitoring is considered in patients undergoing prolonged endoscopic procedures who are at risk of deep sedation. Additionally, standardized discharge criteria should be used to determine the patient’s readiness for discharge. Lastly, physicians should remember that the risk for an unintended deeper level of sedation may be more common after the stimulation of the endoscopic procedure has been removed.
Professor Somchai Amornyotin
Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University
Read the Original
This page is a summary of: Sedation-related complications in gastrointestinal endoscopy, World Journal of Gastrointestinal Endoscopy, January 2013, Baishideng Publishing Group Co., Limited (formerly WJG Press),
DOI: 10.4253/wjge.v5.i11.527.
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