1989 A/S/G/E survey of endoscopic sedation and monitoring practices

Monitoring practices for conscious sedation during gastrointestinal endoscopic procedures are not standardized. A questionnaire was sent to 509 randomly selected A/S/G/E members to define current national sedation and monitoring practices. Responses were returned by 290 members (57%) from 45 states. The average respondent was between 35 and 54 years of age and had 12.4 years of endoscopic experience. Excluding flexible sigmoidoscopy, most patients were routinely sedated for endoscopic procedures. Meperidine (87%), midazolam (73%), diazepam (49%), and naloxone (30%) were the drugs most often used during conscious sedation. When a minor tranquilizer was used, midazolam (62%) was used more often than diazepam (38%). Cardiopulmonary sedation-related complications had a low annual occurrence rate of less than 0.5%. Most endoscopists monitor vital signs before and after procedures (greater than 90%) but less often during procedures (77%). Pulse oximeters and electrocardiographic monitoring were used by 65% and 55% of endoscopists, respectively. Electronic monitoring was used more often for patients undergoing endoscopy in hospitals (99.5%) than in private offices (27%). Fifty-four percent of respondents reported that they had a written endoscopy unit policy concerning conscious sedation. Among endoscopists and gastrointestinal assistants, basic life-support certification was common (76% and 77%, respectively), but advanced cardiac life-support was far less common (30% and 18%). This survey found the use of intravenous conscious sedation for gastrointestinal endoscopic procedures to be safe. Monitoring of patients with vital signs is used regularly; moreover, the majority of endoscopists now also employ electronic monitoring equipment.