David R. Lichtenstein, MD; Sanjay Jagannath, MD; Todd H. Baron, MD, Chair; Michelle A. Anderson, MD; Subhas Banerjee, MD; Jason A. Dominitz, MD, MHS; Robert D. Fanelli, MD, SAGES Representative; S. Ian Gan, MD; M. Edwyn Harrison, MD; Steven O. Ikenberry, MD; Bo Shen, MD; Leslie Stewart, SGNA Representative; Khalid Khan, MD, NAPSGHAN Representative; John J. Vargo, MD, MPH
Gastroenterology 2007;133:675-501 (DOI:10.1053)
BACKGROUND
Sedation may be defined as a drug-induced depression in the level of consciousness. The purpose of sedation and analgesia is to relieve patient anxiety and discomfort, improve the outcome of the examination, and diminish the patient’s memory of the event. Practice guidelines have been put forth by the American Society of Anesthesiologists (ASA) Committee for Sedation and Analgesia by Non-Anesthesiologists, and approved by the ASGE.1,2
Four stages of sedation have been described, ranging from minimal to moderate, deep, and general anesthesia (Table 2). In general, most endoscopic procedures are performed with the patient under moderate sedation, a practice that was formerly referred to as "conscious sedation."
At the level of moderate sedation, the patient, while maintaining ventilatory and cardiovascular function, is able to make purposeful responses to verbal or tactile stimulation. In contrast, a patient undergoing deep sedation cannot be easily aroused but may still respond purposefully to repeated or painful stimulation. Airway support may be required for deep sedation. At the level of general anesthesia, the patient is unarousable to painful stimuli, and cardiovascular function may be impaired.
The level of sedation should be titrated to achieve a safe, comfortable, and technically successful endoscopic procedure. Knowledge of the pharmacologic profiles of sedative agents is necessary to maximize the likelihood that the desired level of sedation is targeted accurately. Individuals differ in their response to sedation, so patients may require different levels of sedation for the same procedure and patients may attain varying levels of sedation during a single procedure. Therefore, practitioners should possess the skills necessary to resuscitate or rescue a patient whose level of sedation is deeper than initially intended. This statement will evaluate the strength of evidence in the medical literature to provide guidelines for the use of sedation and anesthesia during GI endoscopic procedures and is an update of 3 previous ASGE documents.2-4
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