GI Unit Leadership: Optimizing Endoscopy Operations through Leadership (Virtual)

ASGE guideline_sedation

Pdf Summary

The American Society for Gastrointestinal Endoscopy (ASGE) has released updated guidelines on sedation and anesthesia for gastrointestinal (GI) endoscopy. These guidelines are designed to educate endoscopists, enhancing patient care during procedures. The document underwent extensive literature review and expert consultation, and though not a legal standard, it provides comprehensive recommendations considering existing evidence and expert opinion.<br /><br />Sedation aims to alleviate anxiety and discomfort in patients undergoing GI endoscopic procedures, optimizing exam outcomes and reducing memory of the event. Different sedatives and analgesics are employed, with dosing tailored to achieve safety and comfort tailored to individual patient and procedure requirements.<br /><br />The guidelines address varying sedation levels, from minimal sedation, where patients respond normally to verbal commands, to deep sedation, where patients require airway support and may not respond easily. Practitioners are advised to be prepared to rescue patients experiencing deeper than anticipated sedation levels.<br /><br />Pre-procedural assessment is crucial. Patients must give informed consent, understanding the risks and benefits of sedation. Fasting guidelines are suggested to reduce aspiration risk, but there’s recognition that evidence linking fasting duration and aspiration risk is varied.<br /><br />Intra-procedural monitoring includes checking the patient's vital signs, oxygen levels, and sedation depth. Capnography is suggested, especially during deep sedation, to improve safety by detecting respiratory depression early.<br /><br />The guidelines also discuss unsedated endoscopy for suitable patients, emphasize that routine sedation may be unnecessary for some, and outline the use of propofol—a sedative offering rapid recovery but requiring careful monitoring due to potential deeper sedation levels.<br /><br />Anesthesia provider-assisted sedation is recommended for complex procedures or patients with significant comorbidities. However, it is noted that it incurs additional costs without clear safety benefits in routine procedures.<br /><br />Ultimately, these guidelines serve to assist with clinical decisions, emphasizing evidence-based practice, patient safety, and an individualized approach to endoscopic sedation.

Keywords

ASGE guidelines

sedation

anesthesia

gastrointestinal endoscopy

patient care

sedation levels

pre-procedural assessment

intra-procedural monitoring

capnography

propofol