Sedation and anesthesia in gastrointestinal endoscopy in 2025: how, who, and why

Endoscopic sedation is a relevant and challenging component of the endoscopic procedures. Its goals are to relieve patient anxiety and discomfort, improve the outcome of the examination, make the procedure tolerable, and reduce the patient's memory of the event. Unfortunately, sedation may cause a delay in patient recovery and discharge, add to the cost of endoscopic procedures, and increase the risk of adverse events (eg, cardiopulmonary adverse events). Many patients can tolerate endoscopic procedures with moderate sedation using a combination of sedatives and analgesics; however, some patients require deep sedation because of both intolerance and the need for prolonged and complex procedures. Recommendations regarding the nonanesthesiologist administration of propofol differ among guidelines. The British Society of Gastroenterology recommends that propofol be administered by an anesthesiologist or by a second appropriately trained physician who does not perform endoscopy. In contrast, papers from the European Society of Gastrointestinal Endoscopy, the American Society for Gastrointestinal Endoscopy, and the Italian societies state that nonanesthesiologist administration of propofol is safe in selected patients and may improve efficiency in GI units. This review is designed to analyze the preprocedural aspects of sedation and the different sedatives and analgesics used along with their advantages and disadvantages. In addition, we make a comparison between all sedatives and analgesics available in the literature and describe their appropriate use in drug management, patient monitoring, and patient discharge. We finally examine how to manage patients who underwent sedation, identify those who require special care, and discuss when sedation or anesthesia should be used for GI procedures.