Sedation in gastrointestinal endoscopy: an anesthesiologist's perspective

Sedation is required to treat an ever increasing number of patients for medical diagnostic or therapeutic procedures, in particular in gastrointestinal endoscopy. Due to the apparent ease of administration of sedative techniques, and due to the shortage of anesthetic staff in many Western countries, sedation is being carried out more and more frequently by non-anesthesiologist doctors or even paramedical staff. Due to its pharmacokinetic properties, propofol has become the preferred sedative drug used by non-anesthesiologists. However, uncritical use of propofol by nonqualified persons might result in much higher complications rates and even fatal events. Several guidelines have been published with common issues, but also some significant differences. Whether they contribute to improved patient safety or not will depend on the practical application and interpretation of these guidelines. Although further evaluation is needed, computer-assisted systems might contribute to the safe administration of propofol through a better control of the level of sedation.