Sedation and analgesia is the standard of care during diagnostic and therapeutic endoscopic gastrointestinal procedures in most areas of the world. Unsedated endoscopy is feasible in selected patients, but requires commitment on the part of both the patient and the provider. The American Society of Anesthesiologists has defined four stages of sedation, ranging from minimal to moderate, deep and general anesthesia. The level of sedation as well as the choice of sedative is based on the type of procedure, patient characteristics and the existence of the required structural conditions. Individuals administering sedation/analgesia should be trained to rescue a patient who has reached a level of sedation deeper than that intended.

1.
Eckardt VF, Kanzler G, Schmitt T, Eckardt AJ, Bernhard G: Complications and adverse effects of colonoscopy with selective sedation. Gastrointest Endosc 1999;49:560–565.
[PubMed]
2.
Rex DK, Imperiale TF, Portish V: Patients willing to try colonoscopy without sedation: associated clinical factors and results of a randomized controlled trial. Gastrointest Endosc 1999;49:554–559.
[PubMed]
3.
Schreiber F: Austrian Society of Gastroenterology and Hepatology (OGGH) – guidelines on sedation and monitoring during gastrointestinal endoscopy. Endoscopy 2007;39:259–262.
[PubMed]
4.
Baudet JS, Borque P, Borja E, et al: Use of sedation in gastrointestinal endoscopy: a nationwide survey in Spain. Eur J Gastroenterol Hepatol 2009;21:882–888.
[PubMed]
5.
Cohen LB, Wecsler JS, Gaetano JN, et al: Endoscopic sedation in the United States: results from a nationwide survey. Am J Gastroenterol 2006;101:967–974.
[PubMed]
6.
Heuss LT, Froehlich F, Beglinger C: Changing patterns of sedation and monitoring practice during endoscopy: results of a nationwide survey in Switzerland. Endoscopy 2005;37:161–166.
[PubMed]
7.
Ladas SD, Aabakken L, Rey JF, et al: Use of sedation for routine diagnostic upper gastrointestinal endoscopy: a European Society of Gastrointestinal Endoscopy Survey of National Endoscopy Society Members. Digestion 2006;74:69–77.
[PubMed]
8.
Paspatis GA, Manolaraki MM, Tribonias G, et al: Endoscopic sedation in Greece: results from a nationwide survey for the Hellenic Foundation of Gastroenterology and Nutrition. Dig Liver Dis 2009;41:807–811.
[PubMed]
9.
Radaelli F, Meucci G, Sgroi G, Minoli G: Technical performance of colonoscopy: the key role of sedation/analgesia and other quality indicators. Am J Gastroenterol 2008;103:1122–1130.
[PubMed]
10.
Riphaus A, Wehrmann T, Weber B, et al: S3 Guideline: sedation for gastrointestinal endoscopy 2008. Endoscopy 2009;41:787–815.
11.
American Society of Anesthesiologists Task Force on Sedation and Analgesia by Non-Anesthesiologists: Practice guidelines for sedation and analgesia by non-anesthesiologists. Anesthesiology 2002;96:1004–1017.
[PubMed]
12.
Lichtenstein DR, Jagannath S, Baron TH, et al: Sedation and anesthesia in GI endoscopy. Gastrointest Endosc 2008;68:815–826.
[PubMed]
13.
Cohen LB, Delegge MH, Aisenberg J, et al: AGA Institute review of endoscopic sedation. Gastroenterology 2007;133:675–701.
[PubMed]
14.
Patel S, Vargo JJ, Khandwala F, et al: Deep sedation occurs frequently during elective endoscopy with meperidine and midazolam. Am J Gastroenterol 2005;100:2689–2695.
[PubMed]
You do not currently have access to this content.