Asleep on the job: sedation and monitoring during endoscopy

Gastrointestinal endoscopic procedures are invasive and carry a significant morbidity and mortality, even for diagnostic procedures (mortality of 1 in 2000 for upper gastrointestinal endoscopy). The commonest causes of death are cardiopulmonary complications, which may in part be related to sedative techniques. The clinical end-points for sedation need to be reappraised and should aim to induce amnesia rather than hypnosis. Endoscopists need to be familiar with the pharmacokinetic and pharmacodynamic properties of the benzodiazepines used for sedation. This applies particularly to the protracted half-lives of some benzodiazepines and the major drug interaction with significant synergy that occurs if opioids are used in combination with benzodiazepines. Thus appropriate doses of these drugs should be administered. The use of supplemental oxygen and pulse oximetry, combined with continuous intravenous access during the procedure should be standard practice. Endoscopists should be aware of national guidelines for safe endoscopic practice.