Multisociety Sedation Curriculum for Gastrointestinal Endoscopy

Cleveland Clinic Lerner College of Medicine, Department of Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, USA.
Gastroenterology (Impact Factor: 13.93). 05/2012; 143(1):e18-41. DOI: 10.1053/j.gastro.2012.05.001
Source: PubMed
  • The western journal of emergency medicine 03/2013; 14(2):204-204. DOI:10.5811/westjem.2012.10.13864
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    ABSTRACT: National surveys have been used to obtain information on sedation and monitoring practices in endoscopy in several countries. To provide data from Portugal and query the Portuguese endoscopists on nonanesthesiologist administration of propofol. A 31-item web survey was sent to all 490 members of the Portuguese Society of Gastroenterology. A total of 129 members (26%) completed the questionnaire; 57% worked in both public and private practice. Most performed esophagogastroduodenoscopy without sedation (public - 70%; private - 57%) and colonoscopies with sedation (public - 64%; private - 69%). Propofol was the most commonly used agent for colonoscopy, especially in private practice (52 vs. 33%), and it provided the best satisfaction (mean 9.6/10). A total of 94% chose propofol as the preferred sedation for routine colonoscopy. Nonanesthesiologist administration of propofol was performed only by four respondents; however, 71% reported that they would consider its use, given adequate training. Pulse oximetry is monitored routinely (99%); oxygen supplementation is administered by 81% with propofol and 42% with traditional sedation. Most (82%) believed that propofol sedation may increase the uptake of endoscopic screening for colorectal cancer. The use of sedation is routine practice in colonoscopy, but not esophagogastroduodenoscopy. The preferred agent is propofol and it is used almost exclusively by anesthesiologists.
    European Journal of Gastroenterology & Hepatology 03/2015; 27(3):265-70. DOI:10.1097/MEG.0000000000000245 · 2.15 Impact Factor
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    ABSTRACT: Gastrointestinal endoscopies are invasive and unpleasant procedures that are increasingly being used worldwide. The importance of high quality procedures (especially in colorectal cancer screening), the increasing patient awareness and the expectation of painless examination, increase the need for procedural sedation. The best single sedation agent for endoscopy is propofol which, due to its' pharmacokinetic/dynamic profile allows for a higher patient satisfaction and procedural quality and lower induction and recovery times, while maintaining the safety of traditional sedation. Propofol is an anesthetic agent when used in higher doses than those needed for endoscopy. Because of this important feature it may lead to cardiovascular and respiratory depression and, ultimately, to cardiac arrest and death. Fueled by this argument, concern over the safety of its administration by personnel without general anesthesia training has arisen. Propofol usage seems to be increasing but it's still underused. It is a safe alternative for simple endoscopic procedures in low risk patients even if administered by non-anesthesiologists. Evidence on propofol safety in complex procedures and high risk patients is less robust and in these cases, the presence of an anesthetist should be considered. We review the existing evidence on the topic and evaluate the regional differences on sedation practices.
    02/2015; 7(2):102-9. DOI:10.4253/wjge.v7.i2.102