Sedation and Anesthesia in GI Endoscopy

Publication Date: February 1, 2018
Last Updated: March 14, 2022

RECOMMENDATIONS

Recommendations for propofol use during endoscopy

  • A sedation team with appropriate education and training.
  • At least 1 person who is qualified in advanced life support skills (ie, airway management, defibrillation, and the use of resuscitative medications).
  • Trained personnel dedicated to the uninterrupted monitoring of the patient’s clinical and physiologic parameters throughout the procedure should be available.
  • Monitoring
    • Physiologic monitoring must include pulse oximetry, electrocardiography, and intermittent blood pressure measurement.
    • Monitoring oxygenation by pulse oximetry is not a substitute for monitoring ventilatory function.
    • Capnography should be considered because it may decrease the risks during deep sedation.
    • Continuous monitoring will allow recognition of patients who have progressed to a deeper level of sedation.
  • Personnel should have the ability to rescue a patient who becomes unresponsive or unable to protect his or her airway or who loses spontaneous respiratory or cardiovascular function.
  • Age-appropriate equipment for airway management and resuscitation must be immediately available.
  • A physician should be present throughout propofol sedation and must remain immediately available until the patient meets discharge criteria.
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We recommend that all patients undergoing endoscopic procedures be evaluated to assess their risk of sedation related to pre-existing medical conditions. (⊕⊕⊕⊕)
312101
We recommend that the combination of an opioid and benzodiazepine is a safe and effective regimen for achieving minimal to moderate sedation for upper endoscopy and colonoscopy in patients without risk factors for sedation-related adverse events. (⊕⊕⊕⊕)
312101
We suggest using an appropriate adjunctive agent (eg, diphenhydramine, promethazine, or droperidol) in combination with conventional sedative drugs in select clinical circumstances. (⊕⊕oo)
312101
We recommend that providers undergo specific training in the administration of endoscopic sedation and possess the skills necessary for the diagnosis and management of sedation-related adverse events, including rescue from a level of sedation deeper than that intended. (⊕⊕⊕⊕)
312101
We recommend the routine monitoring of blood pressure, oxygen saturation, and heart rate in addition to clinical observation for changes in cardiopulmonary status during all endoscopic procedures using sedation. Supplemental oxygen administration should be considered for moderate sedation and should be administered during deep sedation. Supplemental oxygen should be administered if hypoxemia is anticipated or develops. (⊕⊕⊕⊕)
312101
We suggest that capnography monitoring be considered for patients undergoing endoscopy targeting deep sedation. (⊕⊕oo)
312101
We recommend anesthesia provider–administered sedation be considered for complex endoscopic procedures or patients with multiple medical comorbidities or at risk for airway compromise. (⊕⊕⊕o)
312101
We suggest that endoscopists use propofol-based sedation (endoscopist-directed or anesthesia-provider administered) when it is expected to improve patient safety, comfort, procedural efficiency, and/or successful procedure completion. (⊕⊕oo)
312101

Recommendation Grading

Overview

Title

Sedation and Anesthesia in GI Endoscopy

Authoring Organization

Endorsing Organizations

Publication Month/Year

February 1, 2018

Last Updated Month/Year

August 7, 2023

Supplemental Implementation Tools

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Inclusion Criteria

Female, Male, Adolescent, Adult, Child, Infant, Older adult

Health Care Settings

Emergency care, Hospital, Operating and recovery room, Outpatient

Intended Users

Nurse anesthetist, nurse, nurse practitioner, physician, physician assistant

Scope

Management

Diseases/Conditions (MeSH)

D000760 - Anesthesia and Analgesia, D016099 - Endoscopy, Gastrointestinal

Keywords

anesthesia, sedation, GI endoscopy

Methodology

Number of Source Documents
103
Literature Search Start Date
January 1, 1980
Literature Search End Date
August 1, 2017