Procedural sedation

Abstract

Purpose of review: To encapsulate the recent developments in endoscopic procedural sedation from the standpoints of safety, efficacy and policy.

Recent findings: Initial studies addressing the presence of obstructive sleep apnea in patients undergoing upper endoscopy and colonoscopy did not find an increased risk of cardiopulmonary complications. A worldwide study of 646 080 patients receiving endoscopist-directed propofol sedation found a mortality rate of one per 161 515 cases, which all occurred in patients with high-risk comorbidities. The incidence of bag mask ventilation was significantly higher for upper endoscopy when compared to colonoscopy (185/185 245; 0.1% vs. 20/142 863, 0.01%; P<0.001).

Summary: The presence of obstructive sleep apnea whether diagnosed by a surrogate validated questionnaire to by the gold standard sleep study does not appear to lead to increased rates of hypoxemia in patients undergoing ambulatory upper endoscopy. Endoscopist-directed propofol sedation is well tolerated in the appropriately selected patient. The use of anesthesia-assisted sedation for American Society of Anesthesiologists class I and II patients for upper endoscopy and colonoscopy is cost-ineffective.