title: Sedation in gastrointestinal endoscopy: current issues.
abstract: Diagnostic and therapeutic endoscopy can successfully be performed by applying moderate (conscious) sedation. Moderate sedation, using midazolam and an opioid, is the standard method of sedation, although propofol is increasingly being used in many countries because the satisfaction of endoscopists with propofol sedation is greater compared with their satisfaction with conventional sedation. Moreover, the use of propofol is currently preferred for the endoscopic sedation of patients with advanced liver disease due to its short biologic half-life and, consequently, its low risk of inducing hepatic encephalopathy. In the future, propofol could become the preferred sedation agent, especially for routine colonoscopy. Midazolam is the benzodiazepine of choice because of its shorter duration of action and better pharmacokinetic profile compared with diazepam. Among opioids, pethidine and fentanyl are the most popular. A number of other substances have been tested in several clinical trials with promising results. Among them, newer opioids, such as remifentanil, enable a faster recovery. The controversy regarding the administration of sedation by an endoscopist or an experienced nurse, as well as the optimal staffing of endoscopy units, continues to be a matter of discussion. Safe sedation in special clinical circumstances, such as in the cases of obese, pregnant, and elderly individuals, as well as patients with chronic lung, renal or liver disease, requires modification of the dose of the drugs used for sedation. In the great majority of patients, sedation under the supervision of a properly trained endoscopist remains the standard practice worldwide. In this review, an overview of the current knowledge concerning sedation during digestive endoscopy will be provided based on the data in the current literature.
authors: Department of Gastroenterology and Center for Inflammatory Bowel Disease, "Saint Panteleimon" General Hospital, Nikaia, 12461 Haidari, Greece. jktrian@gmail.com
authors: John K
authors: JK
authors: Triantafillidis
authors: Emmanuel
authors: E
authors: Merikas
authors: Dimitrios
authors: D
authors: Nikolakis
authors: Apostolos E
authors: AE
authors: Papalois
mesh_terms: D002983:Clinical Competence; D016292:Procedural Sedation / Q000009:adverse effects; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects / Q000379:methods*; D019983:Guideline Adherence; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics; D009719:Nurse Anesthetists; D061214:Patient Safety; D018579:Patient Selection; D010561:Personnel Staffing and Scheduling; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D012307:Risk Factors
chemical_list: D006993:Hypnotics and Sedatives
keywords: Analgesia; Digestive system; Endoscopy; Gastrointestinal endoscopy; Sedation
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