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Updated: Jul 11, 2025

Drug-Induced Sleep Endoscopy DISE with Target Controlled Infusion TCI and Bispectral Analysis in Obstructive Sleep Apnea
Published on: December 6, 2016
Issues in Endoscopic Sedation
Lawrence B Cohen1, Ariel A Benson2
1Dr. Cohen serves as Associate Clinical Professor in the Department of Medicine (Division of Gastroenterology) at the Mount Sinai School of Medicine in New York, New York.
Abstract:
The subject of endoscopic sedation continues to generate controversy and debate. This article provides a critical analysis of several key issues related to sedation that have recently been the focus of intense interest. Monitored anesthesia care (MAC) is currently the dominant method of endoscopic sedation for approximately one third of all US gastroenterologists. The benefits and cost-effectiveness of this approach remain unclear, as outlined in this article. An alternative to MAC is the administration of propofol by a specially trained nurse or endoscopy assistant, working under the direction of an endoscopist. The scientific merits of the arguments presented by both those in favor of, and those opposed to, this practice are evaluated. In addition, the clinical experience with endoscopist-directed propofol and the challenges associated with its implementation are presented. Other options for endoscopic sedation may soon be available. One approach is computer-assisted delivery of propofol, which is performed by a physician/nurse team. The clinical studies related to this device, along with several other novel methods of sedation, are described.
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