A safe method for sedating and monitoring patients for upper and lower gastrointestinal endoscopy

Although the incidence of significant complications occurring during endoscopic procedures that require sedation are low, it has been demonstrated that they are usually related to cardiovascular system dysfunction. Such complications are a manifestation of cardiac hypoxia and are a function of the arterial oxygen desaturation. A practical method of monitoring such patients includes continuous oxygen saturation measurements and EKG monitoring. From October, 1987 to July, 1989, a total of 730 endoscopic examinations were performed using a combination of meperidine and midazolam as an intravenous (IV) bolus for sedation. Supplemental nasal oxygen was routinely given at 2 L per minute and real-time monitoring was performed with electrocardiograph and continuous pulse oximeter. There were no deaths and only four untoward events related to medication that altered the course of the examination. Transient hypoxemia that responds to gentle stimulation and bradycardia resolving with cessation of endoscope advancement are viewed as physiologic responses and not complications. All occurrences were immediately identified and corrected appropriately, and no morbidity resulted. With proper monitoring of oxygen saturation, pulse, and cardiac rhythm in a patient with nasal oxygen, IV bolus administration of meperidine and midazolam is a safe and adequate sedation even in the elderly and debilitated patient.