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  • Title: Procedural sedation.
    Author: Vargo JJ.
    Journal: Curr Opin Gastroenterol; 2010 Sep; 26(5):421-4. PubMed ID: 20639757.
    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.
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