The American Society for Gastrointestinal Endoscopy released updated guidelines for sedation and anesthesia in GI endoscopy in Gastrointestinal Endoscopy.
Here are the ASGE Standards of Practice Committee's eight recommendations:
1. All patients undergoing endoscopic procedures should be evaluated to assess their risk of sedation related to pre-existing medical conditions.
2. Use a combination of an opioid and benzodiazepine for a safe and effective regimen for achieving minimal to moderate sedation for upper endoscopy and colonoscopy in patients without risk factors for adverse events related to sedation.
3. In certain clinical circumstances, practioners should also use an agent like diphenhydramine, promethazine or droperidol in combination with conventional sedative drugs.
4. Providers should undergo specific training in administering endoscoping sedation. Providers should have the necessary skills for the diagnosis and management of sedation-related adverse events, including rescue from a level of sedation deeper than that intended.
5. Routine monitoring of blood pressure, oxygen saturation and heart rate in addition to clinical observation for cardiopulmonary status changes during all endoscopic procedures under sedation. Providers should consider supplemental oxygen administration for moderate sedation and should administer it during deep sedation. If hypoxemia is anticipated or develops, supplemental oxygen should be administered.
6. Consider capnography monitoring for patients undergoing endoscopy targeting deep sedation.
7. Consider anesthesia provider-administered sedation for patients with multiple medical comorbidities or risk of airway compromise or during complex endoscopic procedures.
8. Endoscopists should use propofol-based sedation when it is expected to improve patient safety, comfort, procedural efficiency and successful completion of the procedure.
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