title: Sedation for gastrointestinal endoscopy: the changing landscape.
abstract: OBJECTIVE
  Most patients require sedation for gastrointestinal endoscopy. Moderate sedation for these procedures has traditionally been provided by the endoscopist with benzodiazepine and/or a narcotic. As endoscopy has increased in numbers and complexity, however, more effective sedation and analgesia is frequently required. Controversy has ensued over safe and efficient sedation practice. This review seeks to delineate what has been learned about this topic in the recent literature.
  
  
  RESULTS
  There has been an increase both in the number of endoscopic procedures performed and in the use of propofol for endoscopic sedation. Studies have focused on several basic issues: alternatives to anesthesiologist-supervised propofol, other sedation regimens, and complications related to sedation.
  
  
  CONCLUSIONS
  Alternatives to anesthesiologist-supervised propofol include nurse-administered propofol sedation supervised by the endoscopist, and patient controlled sedation. While other sedative regimens continue to be examined, the use of propofol for gastrointestinal endoscopy will continue to increase. Structured nurse-administered propofol programs appear to be safe, but the occurrence of severe respiratory depression and the ability to rescue remain concerns. Further study into appropriate sedation training, patient selection, ability to rescue, complications and value of anesthesiologist-directed sedation is necessary.
authors.affiliation: Department of Anesthesiology, Dartmouth Hitchcock Medical Center, Lebanon, NH 03756, USA. trummel@hitchcock.org
authors.forename: John
authors.initials: J
authors.lastname: Trummel
mesh_terms: D016292:Procedural Sedation / Q000009:adverse effects / Q000451:nursing* / Q000639:trends; D016503:Drug Delivery Systems / Q000379:methods / Q000451:nursing*; D016099:Endoscopy, Gastrointestinal; D005060:Europe; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects / Q000191:economics; D008991:Monitoring, Physiologic; D015742:Propofol / Q000009:adverse effects / Q000191:economics; D014481:United States
chemical_list: D006993:Hypnotics and Sedatives; D015742:Propofol