Sedation and monitoring for gastrointestinal endoscopy

Delivery of safe but effective sedation can be a challenge for the endoscopist. Complications include respiratory depression, aspiration and cardiac arrhythmias, and the cardiopulmonary mortality of endoscopy may exceed that of general anesthesia. To administer sedation properly, it is necessary for endoscopists to understand the definitions and hazards of conscious versus deep sedation, the role of electronic monitoring devices such as pulse oximetry, and the pharmacology of the agonist and reversal agents used. They must develop a systematic approach to sedation in conjunction with well-trained gastrointestinal assistants and know the limitations of their abilities. These topics are reviewed in this article, and a general approach to sedation is presented.