Sedation in endoscopy: Current practices and future innovations
- PMID: 40547560
- PMCID: PMC12179949
- DOI: 10.4253/wjge.v17.i6.106604
Sedation in endoscopy: Current practices and future innovations
Abstract
Sedation practices in gastrointestinal endoscopy have evolved considerably, driven by patient demand for comfort and the need to minimize cardiopulmonary complications. Recent guidelines emphasize personalized sedation strategies, risk assessment, and vigilant hemodynamic monitoring to ensure that sedation depth aligns with each patient's comorbidities and procedural requirements. Within this landscape, the trial by Luo et al highlights the value of adding etomidate to propofol target-controlled infusion, demonstrating significantly reduced hypotension, faster induction, and fewer respiratory complications in typical American Society of Anesthesiologists I-III candidates. These findings align with broader recommendations from both European and American societies advocating sedation regimens that preserve stable circulation. Etomidate's favorable hemodynamic profile, coupled with propofol's reliability, suggests potential applications in advanced endoscopic interventions such as endoscopic retrograde cholangiopancreatography, interventional endoscopic ultrasound, and endoscopic submucosal dissection, where deeper or more sustained sedation is often required. Remimazolam, a novel short-acting benzodiazepine, has similarly been associated with reduced cardiovascular depression and faster recovery, particularly in high-risk populations, although direct comparisons between etomidate-propofol and remimazolam-based regimens remain limited. Further investigations into these sedation strategies in higher-risk cohorts, as well as complex therapeutic endoscopy, will likely inform more nuanced, patient-specific protocols aimed at maximizing both safety and procedural efficiency.
Keywords: Endoscopy sedation; Etomidate; Gastrointestinal endoscopy; Propofol; Remimazolam; Sedation monitoring; Target-controlled infusion.
©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
Conflict of interest statement
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Similar articles
-
Intravenous midazolam infusion for sedation of infants in the neonatal intensive care unit.Cochrane Database Syst Rev. 2003;(1):CD002052. doi: 10.1002/14651858.CD002052. Cochrane Database Syst Rev. 2003. Update in: Cochrane Database Syst Rev. 2012 Jun 13;(6):CD002052. doi: 10.1002/14651858.CD002052.pub2. PMID: 12535424 Updated.
-
Drugs for preventing postoperative nausea and vomiting in adults after general anaesthesia: a network meta-analysis.Cochrane Database Syst Rev. 2020 Oct 19;10(10):CD012859. doi: 10.1002/14651858.CD012859.pub2. Cochrane Database Syst Rev. 2020. PMID: 33075160 Free PMC article.
-
Systemic pharmacological treatments for chronic plaque psoriasis: a network meta-analysis.Cochrane Database Syst Rev. 2021 Apr 19;4(4):CD011535. doi: 10.1002/14651858.CD011535.pub4. Cochrane Database Syst Rev. 2021. Update in: Cochrane Database Syst Rev. 2022 May 23;5:CD011535. doi: 10.1002/14651858.CD011535.pub5. PMID: 33871055 Free PMC article. Updated.
-
Systemic pharmacological treatments for chronic plaque psoriasis: a network meta-analysis.Cochrane Database Syst Rev. 2017 Dec 22;12(12):CD011535. doi: 10.1002/14651858.CD011535.pub2. Cochrane Database Syst Rev. 2017. Update in: Cochrane Database Syst Rev. 2020 Jan 9;1:CD011535. doi: 10.1002/14651858.CD011535.pub3. PMID: 29271481 Free PMC article. Updated.
-
The efficacy and safety of remimazolam tosilate compared with propofol for endoscopic retrograde cholangiopancreatography under monitored anesthesia care: A single-center randomized controlled clinical trial.Heliyon. 2024 Sep 24;10(19):e38349. doi: 10.1016/j.heliyon.2024.e38349. eCollection 2024 Oct 15. Heliyon. 2024. PMID: 39391505 Free PMC article.
References
-
- ASGE Standards of Practice Committee. Early DS, Lightdale JR, Vargo JJ 2nd, Acosta RD, Chandrasekhara V, Chathadi KV, Evans JA, Fisher DA, Fonkalsrud L, Hwang JH, Khashab MA, Muthusamy VR, Pasha SF, Saltzman JR, Shergill AK, Cash BD, DeWitt JM. Guidelines for sedation and anesthesia in GI endoscopy. Gastrointest Endosc. 2018;87:327–337. - PubMed
-
- Dumonceau JM, Riphaus A, Schreiber F, Vilmann P, Beilenhoff U, Aparicio JR, Vargo JJ, Manolaraki M, Wientjes C, Rácz I, Hassan C, Paspatis G. Non-anesthesiologist administration of propofol for gastrointestinal endoscopy: European Society of Gastrointestinal Endoscopy, European Society of Gastroenterology and Endoscopy Nurses and Associates Guideline--Updated June 2015. Endoscopy. 2015;47:1175–1189. - PubMed
-
- Kedar S, Chadha RM. Providing Safe Anesthetic Care and Sedation for GI Endoscopy. Curr Anesthesiol Rep. 2024;14:161–171.
Publication types
LinkOut - more resources
Full Text Sources