Monitoring--the gastroenterologist's view

Better training standards and widespread adoption of monitoring equipment has resulted in a considerable drop in anaesthetic-related deaths. This fall, however, has not been reflected in the field of endoscopy, in which over 50% of the complications and deaths appear to be due to cardiopulmonary problems, suggesting the involvement of sedative drugs. Improvements in monitoring could substantially reduce these problems. Staff should be fully trained in endoscopic, sedative, and resuscitation procedures; equipment and drugs for resuscitation should be immediately to hand; any risk factors in patients who are to undergo endoscopy should be identified, and, when necessary, additional monitoring and safety procedures should be followed. Pulse oximeters can detect oxygen desaturation very early and should be used where risk factors have been identified. Use of oximetry and continuous ECG monitoring will improve the sensitivity of clinical monitoring and may reduce the number of adverse events encountered in endoscopy. Use of supplemental oxygen should be considered.