Conscious Sedation for Endoscopic Procedure: A Systematic Review
,
Abstract
Background: Sedation has a beneficial impact on patient’s tolerance to the endoscopic procedure. Conscious sedation is the anesthetic techniques of choice for endoscopic procedure. Conscious sedation for endoscopic procedure could be with one drug or a combination of drugs. There have been broad variations in sedation procedure between different countries, and even between different units within the same country. All drugs which depress the central nervous system have the ability to produce respiratory or cardiovascular complications. Endoscopy has a recorded mortality of 1 in 2000 and a morbidity rate of 1 in 200. These sedation techniques have their effects on patients.
The main goal of this study is to describe the effects of conscious sedation on patients' outcome for endoscopic procedure.
Methods: The design for this study was a review of literature in the medical databases of PubMed, Scopus, Embase, Cochrane and hand search journals from conferences in English. All studies that evaluated the use of CS for endoscopic procedure were included.
Results: The results showed that the pain level of the patient (visual analogue scale) was substantially positive when conscious sedation was used. Conscious sedation, however is a lightly sedated patient who is conscious, amnesic, co-operative on demand and free from fear and anxiety. It is often used during endoscopic procedures to minimize discomfort and relax the patients. The intraoperative hypotension has also been extreme in some medications relative to others.
Conclusion: The study revealed that CS is reliable and well tolerated anesthetic technique for endoscopic procedures, and is a better option for elective endoscopic procedures
CS benefits for endoscopisit and patient outcome is superior to GA such as; short recovery times, less analgesia requirement, comfortable for patient which in turn, leads to faster induction, faster endoscopy, faster discharge, and faster turnaround time. Patients are usually willing to go home after a couple of hours. Rapid recovery is a benefit not only for patients, but also for hospital and day surgery departments. This increases the overall performance of the endoscopy unit.
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[2] Powers CJ, Dornbos D, Mlynash M, Gulati D, Torbey M, Nimjee SM, et al. Thrombectomy with Conscious Sedation Compared with General Anesthesia: A DEFUSE 3 Analysis. AJNR Am J Neuroradiol. 2019; 40(6):1001-5.
[3] Conigliaro R, Fanti L, Manno M, Brosolo P. Italian Society of Digestive Endoscopy (SIED) Sedation Group. Italian Society of Digestive Endoscopy (SIED) position paper on the non-anaesthesiologist administration of propofol for gastrointestinal endoscopy. Dig Liver Dis. 2017; 49(11):1185-1190.
[4] Waring JP, Baron TH, Hirota WK, Goldstein JL, Jacobson BC, Leighton JA, etal. American Society for Gastrointestinal Endoscopy, Standards of Practice Committee. Guidelines for conscious sedation and monitoring during gastrointestinal endoscopy. Gastrointest Endosc. 2003; 58(3):317-22.
[5] Cohen LB, Delegge MH, Aisenberg J, Brill JV, Inadomi JM, Kochman ML, et al. AGA Institute. AGA Institute review of endoscopic sedation. Gastroenterology. 2007; 133(2):675-701.
[6] Koshy G, Nair S, Norkus EP, Hertan HI, Pitchumoni CS. Propofol versus midazolam and meperidine for conscious sedation in GI endoscopy. Am J Gastroenterol. 2000; 95(6):1476-9.
[7] Yusuff H, Prakash A, Webb S. Safe sedation for the non-anaesthetist. Clin Med (Lond). 2016; 16(2):161-3.
[8] Heuss LT, Schnieper P, Drewe J, Pflimlin E, Beglinger C. Conscious sedation with propofol in elderly patients: a prospective evaluation. Aliment Pharmacol Ther. 2003; 17(12):1493-501.
[9] Wang TH, Lin JT. Worldwide use of sedation and analgesia for upper intestinal endoscopy. Sedation for upper GI endoscopy in Taiwan. Gastrointest Endosc. 1999; 50(6):888-9.
[10] Pollock H, Forman S, Pollock T, Raccasi M. Conscious sedation/local anesthesia in the office-based surgical and procedural facility. Clin Plast Surg. 2013; 40(3):383-8.
[11] Swindle J. Coding for Conscious Sedation. Revenue-cycle Strateg. 2017; 14(2):7.
[12] Garewal D, Powell S, Milan SJ, Nordmeyer J, Waikar P. Sedative techniques for endoscopic retrograde cholangiopancreatography. Cochrane Database Syst Rev. 2012; (6):CD007274.
[13] Sieg A, Hachmoeller-Eisenbach U, Eisenbach T. Prospective evaluation of complications in outpatient GI endoscopy: a survey among German gastroenterologists. Gastrointest Endosc. 2001; 53(6):620-7.
[14] Trevisani L, Sartori S, Gaudenzi P, Gilli G, Matarese G, Gullini S, et al. Upper gastrointestinal endoscopy: are preparatory interventions or conscious sedation effective? A randomized trial. World J Gastroenterol. 2004; 10(22):3313-7.
[15] Balsells F, Wyllie R, Kay M, Steffen R. Use of conscious sedation for lower and upper gastrointestinal endoscopic examinations in children, adolescents, and young adults: a twelve-year review. Gastrointest Endosc. 1997; 45(5):375-80.
[16] Jo YY, Kwak HJ. Sedation Strategies for Procedures Outside the Operating Room. Yonsei Med J. 2019; 60(6):491-499.
[17] Sieg A, bng-Study-Group, Beck S, Scholl SG, Heil FJ, Gotthardt DN, et al. Safety analysis of endoscopist-directed propofol sedation: a prospective, national multicenter study of 24 441 patients in German outpatient practices. J Gastroenterol Hepatol. 2014; 29(3):517-23.
[18] Mahmud N, Berzin TM. Extended Monitoring during Endoscopy. Gastrointest Endosc Clin N Am. 2016; 26(3):493-505.
[19] Sporea I, Popescu A, Sandesc D, Salha CA, Sirli R, Danila M. Sedation during colonoscopy. Rom J Gastroenterol. 2005; 14(2):195-8.
[20] Riphaus A, Rabofski M, Wehrmann T. Endoscopic sedation and monitoring practice in Germany: results from the first nationwide survey. Z Gastroenterol. 2010; 48(3):392-7.
[21] Bell GD, Quine A. Preparation, premedication, and surveillance. Endoscopy. 2006; 38(2):105-9.
[22] Amornyotin S, Leelakusolvong S, Chalayonnawin W, Kongphlay S. Age-dependent safety analysis of propofol-based deep sedation for ERCP and EUS procedures at an endoscopy training center in a developing country. Clin Exp Gastroenterol. 2012; 5:123-8.
[23] Khiani VS, Soulos P, Gancayco J, Gross CP. Anesthesiologist involvement in screening colonoscopy: temporal trends and cost implications in the medicare population. Clin Gastroenterol Hepatol. 2012; 10(1):58-64.
[24] Liu H, Waxman DA, Main R, Mattke S. Utilization of anesthesia services during outpatient endoscopies and colonoscopies and associated spending in 2003-2009. JAMA. 2012; 307(11):1178-84.
[25] Bang JY, Arnoletti JP, Holt BA, Sutton B, Hasan MK, Navaneethan U, et al. An Endoscopic Transluminal Approach, Compared With Minimally Invasive Surgery, Reduces Complications and Costs for Patients With Necrotizing Pancreatitis. Gastroenterology. 2019; 156(4):1027-1040.
[26] Brinjikji W, Murad MH, Rabinstein AA, Cloft HJ, Lanzino G, Kallmes DF. Conscious sedation versus general anesthesia during endovascular acute ischemic stroke treatment: a systematic review and meta-analysis. AJNR Am J Neuroradiol. 2015; 36(3):525-9.
[27] Arrowsmith JB, Gerstman BB, Fleischer DE, Benjamin SB. Results from the American Society for Gastrointestinal Endoscopy/U.S. Food and Drug Administration collaborative study on complication rates and drug use during gastrointestinal endoscopy. Gastrointest Endosc. 1991; 37(4):421-7.
[28] Herman LL, Kurtz RC, McKee KJ, Sun M, Thaler HT, Winawer SJ. Risk factors associated with vasovagal reactions during colonoscopy. Gastrointest Endosc. 1993; 39(3):388-91.
[29] Mokhashi MS, Hawes RH. Struggling toward easier endoscopy. Gastrointest Endosc. 1998; 48(4):432-40.
[30] Pereira S, Hussaini SH, Hanson PJ, Wilkinson ML, Sladen GE. Endoscopy: throat spray or sedation? J R Coll Physicians Lond. 1994; 28(5):411-4.
[31] Lazzaroni M, Bianchi Porro G. Preparation, premedication and surveillance. Endoscopy. 1998; 30(2):53-60.
[32] Triantafillidis JK, Merikas E, Nikolakis D, Papalois AE. Sedation in gastrointestinal endoscopy: current issues. World J Gastroenterol. 2013; 19(4):463-81.
[33] Pennazio M, Spada C, Eliakim R, Keuchel M, May A, Mulder CJ, et al. Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy. 2015; 47(4):352-76.
[34] Spechler SJ, Sharma P, Souza RF, Inadomi JM, Shaheen NJ; American Gastroenterological Association. American Gastroenterological Association technical review on the management of Barrett's esophagus. Gastroenterology. 2011; 140(3):e18-52.
[35] Kelsaka E, Karakaya D, Baris S, Sarihasan B, Dilek A. Effect of intramuscular and intravenous lidocaine on propofol induction dose. Med Princ Pract. 2011; 20(1):71-4.
[36] Wang D, Chen C, Chen J, Xu Y, Wang L, Zhu Z, et al. The use of Propofol as a sedative agent in gastrointestinal endoscopy: a meta-analysis. PLoS One. 2013; 8(1):e53311.
[37] Kimber Craig SA. Regional anaesthesia for caesarean section and what to do if it fails. Anaesth Intens Care Med. 2019; 20(9):474-77.
[38] Crespo J, Terán Á. Endoscopy and sedation: an inseparable binomial for the gastroenterologist. Rev Esp Enferm Dig. 2018; 110(4):250-252.
[39] Rex DK, Schoenfeld PS, Cohen J, Pike IM, Adler DG, Fennerty MB, et al. Quality indicators for colonoscopy. Gastrointest Endosc. 2015; 81(1):31-53.
[40] Yen YH, Lin TF, Lin CJ, Lee YC, Lau HP, Yeh HM. Sex differences in conscious sedation during upper gastrointestinal panendoscopic examination. J Formos Med Assoc. 2011; 110(1):44-9.
[41] Czwornog J, Austin GL. Body mass index, age, and gender affect prep quality, sedation use, and procedure time during screening colonoscopy. Dig Dis Sci. 2013; 58(11):3127-33.
[42] Cooper GS, Kou TD, Rex DK. Complications following colonoscopy with anesthesia assistance: a population-based analysis. JAMA Intern Med. 2013; 173(7):551-6.
[43] Vargo JJ, Niklewski PJ, Williams JL, Martin JF, Faigel DO. Patient safety during sedation by anesthesia professionals during routine upper endoscopy and colonoscopy: an analysis of 1.38 million procedures. Gastrointest Endosc. 2017; 85(1):101-108.
[44] ASGE Standards of Practice Committee, Early DS, Lightdale JR, Vargo JJ, Acosta RD, Chandrasekhara V, et al. Guidelines for sedation and anesthesia in GI endoscopy. Gastrointest Endosc. 2018; 87(2):327-337.
[45] Wernli KJ, Brenner AT, Rutter CM, Inadomi JM. Risks Associated With Anesthesia Services During Colonoscopy. Gastroenterology. 2016; 150(4):888-94.
[46] Manani G, Facco E, Favero L, Favero GA, Berengo M, Stellini E, et al. Comparison by means of bispectral index score, between anxiolysis induced by diazepam and sedation induced by midazolam. Minerva Stomatol. 2011; 60(7-8):365-81.
[47] Huq S, Smyth C, Kazmi S, Giles T, Walshaw M, Binukrishnan S, et al. P183 Comparison of patient satisfaction between endobronchial ultrasound and flexible bronchoscopy performed under conscious sedation: a prospective study FREE. FLGastro. 2017; 66(4):100842.
[48] Rahmi G, Samaha E, Vahedi K, Ponchon T, Fumex F, Filoche B, et al. Multicenter comparison of double-balloon enteroscopy and spiral enteroscopy. J Gastroenterol Hepatol. 2013; 28(6):992-8.
[49] Heuss LT, Schnieper P, Drewe J, Pflimlin E, Beglinger C. Safety of propofol for conscious sedation during endoscopic procedures in high-risk patients-a prospective, controlled study. Am J Gastroenterol. 2003; 98(8):1751-7.
[50] Che K, Muckova N, Olafsson S, Srikureja W. Safety of same-day endoscopic ultrasound and endoscopic retrograde cholangiopancreatography under conscious sedation. World J Gastroenterol. 2010; 16(26):3287-91.
[51] Kamani L, Memon AL, Anwar A. Safety of Conscious Sedation in Patients Undergoing Endoscopic Retrograde Cholangio Pancreatography. J Coll Physicians Surg Pak. 2018; 28(12):950-952.
[52] Cho YS, Shin SY, Hwang C, Seo J, Choi JW, Park BK, et al. Safety and Effectiveness of Endoscopist-Directed Nurse-Administered Sedation during Gastric Endoscopic Submucosal Dissection. Gastroenterol Res Pract. 2017; 2017:4723626.
[53] Amornyotin S, Chalayonnavin W, Kongphlay S. Propofol-Based Sedation Does Not Increase Rate of Complication during Percutaneous Endoscopic Gastrostomy Procedure. Gastroenterol Res Pract. 2011; 2011:134819.
[54] Lotfy MA, Ayaad M, El-Kalla R. Percutaneous endoscopic gastrostomy under conscious sedation. Ain-Shams J Anaesth. 2015; 8(2):223-9.
[55] Abe K, Tominaga K, Kanamori A, Suzuki T, Kino H, Nakano M, et al. Safety and Efficacy of Nonanesthesiologist-Administrated Propofol during Endoscopic Submucosal Dissection of Gastric Epithelial Tumors. Gastroenterol Res Pract. 2019; 2019:5937426.
[56] Kinugasa H, Higashi R, Miyahara K, Moritou Y, Hirao K, Ogawa T, et al. Dexmedetomidine for conscious sedation with colorectal endoscopic submucosal dissection: a prospective double-blind randomized controlled study. Clin Transl Gastroenterol. 2018; 9(7):167.
[57] Dzeletovic I, Harrison ME, Crowell MD, Ramirez FC, Yows CR, Harris LA, et al. Impact of fentanyl in lieu of meperidine on endoscopy unit efficiency: a prospective comparative study in patients undergoing EGD. Gastrointest Endosc. 2013; 77(6):883-7.
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| Files | ||
| Issue | Vol 7 No 2 (2021): Spring |
|
| Section | Review Article(s) | |
| DOI | https://doi.org/10.18502/aacc.v7i2.6302 | |
| Keywords | ||
| Conscious sedation Endoscopic procedure Patient's outcome | ||
| Rights and permissions | |
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Hussain Khan Z, Al-fadhili F. Conscious Sedation for Endoscopic Procedure: A Systematic Review. Arch Anesth & Crit Care. 2021;7(2):87-95.
