ASGE Annual GI Advanced Practice Provider Course - Onboarding Day One (On-Demand) | April 2022-06_Sedation and Analgesia in GI Endoscopy

06_Sedation and Analgesia in GI Endoscopy - Heagy

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This document provides information on sedation and analgesia in gastrointestinal (GI) endoscopy. Sedation is a drug-induced depression in the level of consciousness and its objectives include relieving patient anxiety and discomfort, improving the outcome of the exam, and diminishing the patient's memory of the event. There are different levels of sedation, ranging from minimal sedation to general sedation, with varying effects on responsiveness, airway, spontaneous ventilation, and cardiovascular function.<br /><br />Informed consent is crucial and should discuss the benefits, risks, and alternatives to the sedation plan. NPO (nothing by mouth) status is aimed at minimizing aspiration risk and guidelines vary between institutions, though some recommend NPO for 6-8 hours before the procedure. A pre-procedural assessment should include a patient's medical history, physical examination, Mallampati score (which predicts difficulty with endotracheal intubation), and ASA sedation classification.<br /><br />There are exclusion criteria for ambulatory surgical centers (ASC) which may require assessment by an anesthesia provider prior to scheduling. The document lists absolute and relative exclusion criteria, such as BMI over 50, severe lung disease, and severe cognitive impairment.<br /><br />Risks for potential difficult airway are outlined, including previous problems with anesthesia or sedation, certain facial and oral abnormalities, and neck or jaw abnormalities. Preprocedural documentation and time out are JCAHO requirements. Anesthesia provider assistance should be considered for certain situations, such as prolonged or therapeutic endoscopic procedures, increased risk for adverse events, or increased risk for airway obstruction.<br /><br />Unsedated endoscopy may be tolerated in carefully selected patients, but moderate sedation is commonly used, with benzodiazepines for anxiety and amnesia and opioids for pain. Deep sedation can be achieved with non-anesthesia administered propofol (NAAP), though its use is regulated by state policies and limited to non-anesthesia providers.<br /><br />Anesthesiologists administered sedation (MAC) may have advantages such as improved patient satisfaction and decreased distraction for endoscopists, but may come with separate charges and possible increased risks.<br /><br />In terms of practice pearls, preprocedural assessment is important for selecting the location and sedation/anesthesia plan. Informed consent should include discussing risks of sedation/analgesia, and someone who is alert and oriented should complete the consent. Exclusion criteria should be established for ASCs.

Keywords

sedation

analgesia

endoscopy

consciousness

NPO status

pre-procedural assessment

exclusion criteria

deep sedation

propofol

MAC