Austrian Society of Gastroenterology and Hepatology (ÖGGH) - Guidelines on sedation and monitoring during gastrointestinal endoscopy

Introduction

The increasing invasiveness of endoscopic examinations and interventions means that adequate sedation and appropriate patient monitoring are required. Overall, endoscopic interventions in the gastrointestinal tract are low risk, provided that they are performed in sufficient numbers by experienced personnel [1]. The risk of the examination or intervention depends primarily on the invasiveness and technical complexity of the procedure, but also on the patient’s individual risk profile and the specific side-effect profile of the sedatives or anesthetics used. The overall rate of serious complications in gastroenterological examinations and interventions is between 1 in 1000 and 1 in 7500 [2].

The quality of procedures and, in turn, patient safety depend greatly on precise and careful risk estimation before, during, and after the procedure. Information provided to patients on the planned procedure should not only be timely and cover the invasiveness of the procedure - it should include information not only on the risks of the procedure itself but also on the specific risks of sedation.

References

• 1 Sieg A, Hachmöller-Eisenbach U, Eisenbach T. et al . Prospective evaluation of complications in outpatient GI endoscopy: a survey among German gastroenterologists.  Gastrointest Endosc. 2001;  53 620-627
• 2 Daneshmend T K, Bell G D, Logan R F. Sedation for upper GI endoscopy: results of a nationwide survey.  Gut. 1991;  32 12-15
• 3 Arrowsmith J B, Gerstmann BB, Fleischer D E, Benjamin S B. Results from the American Society for Gastrointestinal Endoscopy/US Food and Drug Administration collaborative study on complication rates and drug use during gastrointestinal endoscopy.  Gastrointest Endosc. 1991;  37 421-427
• 4 Dinges Y, Hahn M, Jung M. Troponin I zur Erfassung subklinischer kardialer Ischämien bei der ERCP.  Z Gastroenterol. 2000;  38 763
• 5 Fröhlich F, Schwizer W, Thorens J. et al . Conscious sedation for gastroscopy: patient tolerance and cardiorespiratory parameters.  Gastroenterology. 1995;  108 697-704
• 6 Gatto G, Peri V, Amuso M, Traina M. Sedation is not needed for upper gastrointestinal endoscopy.  Endoscopy. 1996;  28 (Suppl) 41
• 7 Lee M G, Hanna W, Harding H. Sedation for upper gastrointestinal endoscopy: a comparative study of midazolam and diazepam.  Gastrointest Endosc. 1989;  35 82-84
• 8 Abraham N S, Raman M, Thompson K. et al . Treatment efficacy and safety related to the use of propofol vs. conventional sedation: a meta-analysis of published controlled trials.  GI Endos. 2004;  59 AB128
• 9 Clarke A C, Chiragakis L, Hillman L C, Kaya G L. Sedation for endoscopy: the safe use of propofol by general practitioner sedationists.  Med J Aust. 2002;  176 159-162
• 10 Cohen L, Dubovsky A, Aisenberg J, Miller K. Propofol for endoscopic sedation: a protocol for safe and effective administration by the gastroenterologist.  Gastrointest Endosc. 2003;  58 725-732
• 11 Rex K R, Overley C h, Kinser K. et al . Safety of propofol administered by registered nurses with gastroenterologist supervision in 2000 endoscopic cases.  Am J Gastroenterol. 2002;  97 1159-1164
• 12 Walker J A, McIntyre R D, Schleinitz P F. et al . Nurse-administered propofol sedation without anesthesia specialists in 9152 endoscopic cases in an ambulant surgery center.  Am J Gastroenterol. 2003;  98 1744-1750
• 13 Heuss L T, Schnieper P, Drewe J. et al . Risk stratification and safe administration of propofol by registered nurses supervised by the gastroenterologist: a prospective observational study of more than 2000 cases.  Gastrointest Endosc. 2003;  57 664-671
• 14 Heuss L T, Schnieper P, Drewe J. et al . Safety of propofol for conscious sedation during endoscopic procedures in high-risk patients: a prospective, controlled study.  Am J Gastroenterol. 2003;  98 1751-1757
• 15 Bell G D, Jones J G. Routine use of pulse oximetry and supplemental oxygen during endoscopic procedures under conscious sedation: British beef or common sense?.  Endoscopy. 1996;  28 718-721
• 16 Holm C, Rosenberg J. Pulse oximetry and supplemental oxygen during gastrointestinal endoscopy: a critical review.  Endoscopy. 1996;  28 703-711
• 17 American Society of Anesthesiologists . Practice guidelines for sedation and analgesia by non-anesthesiologists.  Anesthesiology. 2002;  96 1004-1017
• 18 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