Conscious sedation for endoscopic and non-endoscopic interventional gastrointestinal procedures: meeting patients' expectations, missing the standard.
OBJECTIVE
To assess the level of sedation, patient satisfaction and frequency of unplanned events with conscious sedation for interventional procedures.


METHODS
One hundred and seventeen patients were assessed prospectively before, during and after procedures. Blood pressure, pulse, oxygen saturation and sedation level were monitored and patients followed up after 24 h. Sedation was scored after drugs were given in accordance with an established protocol. Doses were recorded, as were patients' weight, age and ASA grade and any unplanned events and their management.


RESULTS
Seventy-six of the 117 patients (65%) had no unplanned event, 20 (17.1%) became agitated, 15 (12.8%) hypotensive, three (2.6%) hypoxic and three (2.6%) had more than one response. Twelve patients required active management. Fifty-two (44.4%) had a sedation level of </=3 (responsive to verbal commands), but 39 (33.3%) reached level 6. Median doses were midazolam 6 mg (1-20 mg) and pethidine 50 mg (12.5-100 mg). Ninety-three percent were satisfied with their sedation. No adverse effects were observed after 24 h.


CONCLUSIONS
Despite using a sedation protocol, unplanned events occurred in 35% (95% CI=27-44%) of patients, although not all required active management. The sedation levels reached in some exceeded guidelines. Unplanned events were commoner with increased sedation level. Patient satisfaction was high and no permanent damage was observed.
Marriott
P
P
Academic Department of GI-Radiology, South Manchester University Hospitals NHS Trust, Manchester, UK.
Laasch
H-U
HU
Wilbraham
L
L
Marriott
A
A
England
R E
RE
Martin
D F
DF
D000759:Adjuvants, Anesthesia; D000368:Aged; D019162:Anesthetics, Combined; D001007:Anxiety / Q000209:etiology; D016292:Procedural Sedation / Q000009:adverse effects / Q000379:methods*; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D005767:Gastrointestinal Diseases / Q000601:surgery*; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology; D008297:Male; D008614:Meperidine / Q000008:administration & dosage; D008874:Midazolam / Q000008:administration & dosage; D010149:Postoperative Pain / Q000209:etiology; D017060:Patient Satisfaction; D011446:Prospective Studies
D000759:Adjuvants, Anesthesia; D019162:Anesthetics, Combined; D008614:Meperidine; D008874:Midazolam