Sedation and preparation

Although many editorials for sedation in gastrointestinal endoscopy have been published over recent years, sedation and surveillance seems to be a topic for a never-ending story. Many recently published data have shown that sedation with short-acting propofol seems to be the ideal drug for endoscopic procedures, whether for diagnostic [1] [2] [3] [4] [5] [6] [7] or therapeutic [3] purposes, even in elderly high-risk patients [8], and is therefore recommended as the first choice in the currently published international guidelines [9] [10] [11]. Newer indications for the use of propofol have been investigated. In a recently published randomized controlled trial (RCT) the use of propofol was compared with midazolam for sedation for upper gastrointestinal endoscopy in patients with liver cirrhosis. Results showed that the advantage of propofol lies in the avoidance of acute deterioration of minimal encephalopathy in these patients [12].

References

• 1 McQuaid K R, Laine L. A systematic review and meta-analysis of randomized, controlled trials of moderate sedation for routine endoscopic procedures.  Gastrointest Endosc. 2008;  67 910-923
• 2 Dewitt J, McGreevy K, Sherman S, Imperiale T F. Nurse-administered propofol sedation compared with midazolam and meperidine for EUS: a prospective, randomized trial.  Gastrointest Endosc. 2008;  68 499-509
• 3 Jung M, Hofmann C, Kiesslich R, Brackertz A. Improved sedation in diagnostic and therapeutic ERCP: propofol is an alternative to midazolam.  Endoscopy. 2000;  32 233-238
• 4 Meining A, Semmler V, Kassem A M et al. The effect of sedation on the quality of upper gastrointestinal endoscopy: an investigator-blinded, randomized study comparing propofol with midazolam.  Endoscopy. 2007;  39 345-349
• 5 Singh H, Poluha W, Cheung M et al. Propofol for sedation during colonoscopy.  Cochrane Database Syst Rev. 2008;  (4) CD006268
• 6 Riphaus A, Gstettenbauer T, Frenz M B, Wehrmann T. Quality of psychomotor recovery after propofol sedation for routine endoscopy: a randomized and controlled study.  Endoscopy. 2006;  38 677-683
• 7 Horiuchi A, Nakayama Y, Katsuyama Y et al. Safety and driving ability following low-dose propofol sedation.  Digestion. 2008;  78 190-194
• 8 Riphaus A, Stergiou N, Wehrmann T. Sedation with propofol for routine ERCP in high-risk octogenarians: a randomized, controlled study.  Am J Gastroenterol. 2005;  100 1957-1963
• 9 Riphaus A, Wehrmann T, Weber B et al. S3 Guideline: Sedation for gastrointestinal endoscopy 2008.  Endoscopy. 2009;  41 787-815
• 10 Vargo J J, Cohen L B, Rex D K et al. Position statement: Nonanesthesiologist administration of propofol for GI endoscopy.  Am J Gastroenterol. 2009;  104 2886-2892
• 11 Dumonceau J M, Riphaus A, Aparicio J R et al. European Society of Gastrointestinal Endoscopy, European Society of Gastroenterology and Endoscopy Nurses and Associates, and the European Society of Anesthesiology Guideline: Non-anesthesiologist administration of propofol for GI endoscopy.  Endoscopy. 2010;  42 960-974
• 12 Riphaus A, Lechowicz I, Frenz M B, Wehrmann T. Propofol sedation for upper gastrointestinal endoscopy in patients with liver cirrhosis as an alternative to midazolam to avoid acute deterioration of minimal encephalopathy: a randomized, controlled study.  Scand J Gastroenterol. 2009;  44 1244-1251
• 13 Amorós A, Aparicio J R, Garmendia M et al. Deep sedation with propofol does not precipitate hepatic encephalopathy during elective upper endoscopy Gastrointest.  Endosc. 2009;  70 262-268
• 14 Heuss L T, Froehlich F, Beglinger C. Changing patterns of sedation and monitoring practice during endoscopy: results of a nationwide survey in Switzerland.  Endoscopy. 2005;  37 161-166
• 15 Riphaus A, Rabofski M, Wehrmann T. Endoscopic sedation and monitoring practice in Germany: Results from the first nationwide survey.  Z Gastroenterol. 2010;  48 392-397
• 16 Cohen L B, Wecsler J S, Gaetano J N et al. Endoscopic sedation in the United States: results from a nationwide survey.  Am J Gastroenterol. 2006;  101 967-974
• 17 Revised Hospital Anesthesia Services Interpretive Guidelines. Available at URL: www.cms.gov/SurveyCertificationGenInfo/downloads/SCLetter10_09.pdf . 
• 18 Inadomi J M, Gunnarsson C L, Rizzo J A, Fang H. Projected increased growth rate of anesthesia professional-delivered sedation for colonoscopy and EGD in the United States: 2009 to 2015.  Gastrointest Endosc. 2010;  72 580-586
• 19 Rex D, Deenadayalu V, Eid E et al. Endoscopist-directed administration of propofol: a worldwide safety experience.  Gastroenterology. 2009;  137 1229-1237
• 20 Sharma V K, Nguyen C C. National study of the cardiopulmonary unplanned events after GI endoscopy.  Gastrointest Endosc. 2007;  66 27-34
• 21 Kawashima Y, Takahashi S, Suzuki M et al. Anesthesia-related mortality and morbidity over a 5-year period in 2,363,038 patients in Japan.  Acta Anaesthesiol Scand. 2003;  47 809-817
• 22 Newland M C, Ellis S J, Lydiatt C A et al. Anesthetic-related cardiac arrest and its mortality: a report covering 72,959 anesthetics over 10 years from a US teaching hospital.  Anesthesiology. 2002;  97 108-115
• 23 Gibbs N, Rodoreda P. Anaesthetic mortality rates in Western Australia 1980 – 2002.  Anaesth Intensive Care. 2005;  33 616-622
• 24 Arbous M S, Grobbee D E, van Kleef J W et al. Mortality associated with anaesthesia: a qualitative analysis to identify risk factors.  Anaesthesia. 2001;  56 1141-1153
• 25 Lagasse R S. Anesthesia safety: model or myth? A review of the published literature and analysis of current original data.  Anesthesiology. 2002;  97 1609-1617
• 26 Cohen M M, Duncan P G, Tate R B. Does anesthesia contribute to operative mortality?.  JAMA. 1988;  260 2859-2863
• 27 Cohen L B, Delegge M H, Aisenberg J et al. AGA institute review of endoscopic sedation.  Gastroenterology. 2007;  133 675-701
• 28 Byrne M F, Chiba N, Singh H, Sadowski D C. Propofol use for sedation during endoscopy in adults: a Canadian Association of Gastroenterology position statement.  Can J Gastroenterol. 2008;  22 457-459
• 29 Knape J T, Adriaensen H, van Aken H et al. Guidelines for sedation and/or analgesia by non-anaesthesiology doctors.  Eur J Anaesthesiol. 2007;  24 563-567
• 30 Welchman S, Cochrane S, Minto G et al. Systematic review: the use of nitrous oxide gas for lower gastrointestinal endoscopy.  Aliment Pharmacol Ther. 2010;  32 324-333
• 31 Crispin A, Birkner B, Munte A et al. Process quality and incidence of acute complications in a series of more than 230 000 outpatient colonoscopies.  Endoscopy. 2009;  41 1018-1025
• 32 Harewood G W, Sharma V K, de Garmo P. Impact of colonoscopy preparation quality on detection of suspected colonic neoplasia.  Gastrointest Endosc. 2003;  58 76-79
• 33 Froehlich F, Wietlisbach V, Gonvers J J et al. Impact of colonic cleansing on quality and diagnostic yield of colonoscopy: the European Panel of Appropriateness of Gastrointestinal Endoscopy European multicenter study.  Gastrointest Endosc. 2005;  61 378-384
• 34 Cohen L B. Split dosing of bowel preparations for colonoscopy: an analysis of its efficacy, safety, and tolerability.  Gastrointest Endosc. 2009;  72 406-412
• 35 Ell C, Fischbach W, Bronisch H J et al. Randomized trial of low-volume PEG solution versus standard PEG + electrolytes for bowel cleansing before colonoscopy.  Am J Gastroenterol. 2008;  103 883-893
• 36 Wehrmann T, Riphaus A. Sedation, surveillance, and preparation.  Endoscopy. 2009;  41 86-90
• 37 Marmo R, Rotondano G, Riccio G et al. Effective bowel cleansing before colonoscopy: a randomized study of split-dosage versus non-split dosage regimens of high-volume versus low-volume polyethylene glycol solutions.  Gastrointest Endosc. 2010;  72 313-320
• 38 Park S S, Sinn D H, Kim Y H et al. Efficacy and tolerability of split-dose magnesium citrate: low-volume (2 liters) polyethylene glycol vs. single- or split-dose polyethylene glycol bowel preparation for morning colonoscopy.  Am J Gastroenterol. 2010;  195 1319-1326
• 39 Rostom A, Jolicoueur E. Validation of a new scale for the assessment of bowel preparation quality.  Gastrointest Endosc. 2004;  59 482-486