Sedation and Monitoring for Gastrointestinal Endoscopy: Worldwide Attitudes and Evidence

Sedation and analgesia during gastrointestinal endoscopy is still a matter of debate. The optimal sedation strategy should be pre planned before endocopic procedure and tailored to the patient, based on specific risks and type of procedure. Use of sedation during GI endoscopy has increased worldwide over the last 15 years although the varies from a country to another: some surveys around the world have investigated this issue. Most procedures are performed under moderate sedation combining benzodiazepine with opioid but endoscopic procedures have increased in number and complexity and some drawbacks have emerged. The introduction of propofol has changed gastroenterologists' and patients' attitude toward sedation and several studies have indicated that propofol is more effective and safer than standard sedation for reaching and maintaining an adequate sedation level during endoscopy, since it provides easier titration of the desired sedation level and a shorter recovery time. Nevertheless its narrow therapeutic window and the lack of reversal agents actually increases the risk for complications in cases of inappropriate administration, so that its use by nonanaesthesiologists requires prominent clinical experience and has been limited in many countries. However many studies have shown that non-anesthesiologist propofol sedation is safe and effective if appropriate patient selection is applied and non-anesthesiologist sedation providers have acquired adequate skill and knowledge through dedicated theoretical and practical training programs. In conclusion, sedation practices differ from one country to another country reflecting many different factors including costs, availability of drugs, devices and professional training courses on cardiopulmonary resuscitation.