Risk management regarding sedation/analgesia.
Because the definition of standard of care changes with time, it is difficult to predict whether any given technique or practice will be ultimately viewed as the next advance in care or will be discarded as unnecessary or cumbersome. It is too early to tell whether deep sedation/analgesia with propofol or some other ultrashort acting anesthetic will emerge as the sedative/analgesic of choice for routine endoscopic practice. It seems that deep sedation with propofol provides some advantages over current narcotic/benzodiazepine combinations in many circumstances, but potential risks exist. Further information, including careful documentation of the complications that occur with this and similar agents, be they attributable to the drug or the level of sedation, are eagerly awaited. For now, it seems prudent to continue to recommend that the level of sedation/analgesia be appropriate to the perceived need and that patients continue to have their procedures performed with safety, comfort, and competence as the overriding concerns.
Petrini
John
J
Division of Gastroenterology, Sansum-Santa Barbara Medical Clinic, CA 93105, USA. john@petrini.net
Egan
James V
JV
D000698:Analgesia / Q000009:adverse effects*; D016292:Procedural Sedation / Q000009:adverse effects*; D016099:Endoscopy, Gastrointestinal; D006801:Humans; D008318:Malpractice; D012308:Risk Management