ASGE Annual GI Advanced Practice Provider Course (Virtual) - Onboarding (Day One) | March 2023-Informed Consent Sedation and Bowel Prep

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In this document, Dr. John A. Martin discusses the topics of informed consent, sedation, and bowel preparation in the context of endoscopic procedures. <br /><br />Regarding informed consent, Dr. Martin emphasizes that it is a process, not just a document. He explains that it involves disclosing the nature of the procedure, its benefits, risks, alternatives, and limitations to the patient. Using layman's terms and encouraging patient participation are important in ensuring understanding. Dr. Martin also mentions the importance of discussing possible complications and worst-case scenarios, documenting the consent process, and having a witness present.<br /><br />In terms of sedation, Dr. Martin outlines the various levels of sedation, from minimal to deep sedation (monitored anesthesia care) and general anesthesia. He discusses the goals of sedation, including relieving anxiety and discomfort, improving the performance of the endoscopic examination, and reducing the patient's memory of the procedure. He also provides guidelines for the NPO (nothing by mouth) status before the procedure and highlights the importance of assessing the patient's medical history, medication use, and airway before administering sedation.<br /><br />For bowel preparation, Dr. Martin recommends using a split dose regimen, with the first dose taken the day before the procedure and the second dose on the day of the procedure. He mentions different types of bowel preparations, such as isosmotic, hyposmotic, hyperosmotic, and combination agents, and discusses their efficacy and tolerability. He also considers special considerations for certain patient populations, such as the elderly, those with comorbid diseases or inflammatory bowel disease, and patients who have undergone bariatric surgery.<br /><br />Dr. Martin concludes by providing practice pearls, including the importance of patient education and communication in the informed consent process, proper assessment and monitoring during sedation, and the need for thorough bowel preparation for accurate visualization during endoscopic procedures. He suggests referring to the ASGE guidelines for further information on salvage strategies for inadequate cleansing and failed prior prep due to constipation.

Asset Subtitle

John Martin, MD, FASGE

Keywords

informed consent

sedation

bowel preparation

endoscopic procedures

layman's terms

complications

NPO status

medical history

efficacy

ASGE guidelines