ASGE Annual GI Advanced Practice Provider Course (Virtual) - Onboarding Day One | 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 defined as a drug-induced depression in the level of consciousness with the objectives of relieving patient anxiety, discomfort, improving the outcome of the exam, and dimming the patient's memory of the event. There are different levels of sedation, including minimal sedation, moderate sedation, deep sedation, and general sedation, each with varying levels of responsiveness, airway, spontaneous ventilation, and cardiovascular function.<br /><br />Informed consent is important in discussing the benefits, risks, and limitations, as well as possible alternatives to the sedation plan. NPO (nil per os, nothing by mouth) status is aimed at minimizing aspiration risk and the guidelines for NPO status can vary between institutions.<br /><br />The pre-procedural assessment involves taking a history of snoring, stridor, sleep apnea, medications, drug allergies, adverse reactions to sedation/anesthesia, last oral intake, and substance use. A physical exam is also performed, including vital signs, level of consciousness, Mallampati score (to identify potential obstructive sleep apnea), and a heart/lung exam. The American Society of Anesthesiologists (ASA) sedation classification is used to assess the patient's condition.<br /><br />Exclusion criteria for ambulatory surgery centers (ASC) are discussed, which include absolute and relative exclusion criteria based on various medical conditions. Risks for potential difficult airway are also listed, such as previous problems with anesthesia or sedation, oral abnormalities, neck abnormalities, and jaw abnormalities.<br /><br />Guidelines for anesthesia provider assistance during GI endoscopy are mentioned for situations requiring prolonged or therapeutic procedures, increased risk for adverse events or airway obstruction, and anticipated intolerance to standard sedatives.<br /><br />Different levels of sedation are explained, including unsedated endoscopy, moderate sedation (administered by nurses under endoscopist's guidance), and deep sedation using non-anesthesia administered propofol (NAAP), which is regulated by state/regional/local policies.<br /><br />The advantages and disadvantages of anesthesiologist-administered sedation (MAC) are discussed, including improved patient satisfaction and shorter sedation/recovery times, separate charge for anesthesia, and potential increased risk of complications.<br /><br />The document highlights the importance of pre-procedural assessment, informed consent, and setting exclusion criteria for ASCs in selecting the location of procedures and developing a sedation/anesthesia plan.<br /><br />Two polling questions on Mallampati Classification and risk for potential difficult airway are provided.

Keywords

sedation

analgesia

gastrointestinal endoscopy

levels of sedation

informed consent

NPO status

pre-procedural assessment

exclusion criteria

anesthesia provider assistance

anesthesiologist-administered sedation