Gastroenterology
Volume 133, Issue 2 , Pages 675-701 , August 2007

AGA Institute Review of Endoscopic Sedation

  • Lawrence B. Cohen

      Affiliations

    • The Mount Sinai School of Medicine, New York, New York
    • Corresponding Author InformationAddress requests for reprints to: Chair, Clinical Practice and Quality Management Committee, AGA Institute National Office, c/o Membership Department, 4930 Del Ray Avenue, Bethesda, Maryland 20814. fax: (301) 654-5920.
    • ,
  • Mark H. DeLegge

      Affiliations

    • Medical University of South Carolina, Charleston, South Carolina
    • ,
  • James Aisenberg

      Affiliations

    • The Mount Sinai School of Medicine, New York, New York
    • ,
  • Joel V. Brill

      Affiliations

    • Predictive Health, LLC, Phoenix, Arizona
    • ,
  • John M. Inadomi

      Affiliations

    • University of California, San Francisco, San Francisco, California
    • ,
  • Michael L. Kochman

      Affiliations

    • Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
    • ,
  • Joseph D. Piorkowski Jr

      Affiliations

    • The Piorkowski Law Firm, Washington, District of Columbia

References 

  1. Cohen LB, Wecsler JS, Gaetano JN, Benson AA, Miller KM, Durkalski V, et al. Endoscopic sedation in the United States: results from a nationwide survey. Am J Gastroenterol. 2006;101:967–974
  2. Campo R, Brullet E, Junquera F, Puig-Divi V, Vergara M, Calvet X, et al. Sedation in digestive endoscopy (Results of a hospital survey in Catalonia (Spain)). Gastroenterol Hepatol. 2004;27:503–507
  3. 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
  4. Huang YY, Lee HK, Juan CH, Hastorf P, Tsai SK, Tsou MY. Conscious sedation in gastrointestinal endoscopy. Acta Anaesthesiol Taiwan. 2005;43:33–38
  5. Gross JB, Bailey PL, Connis RT, Cote CJ, Davis FG, Epstein BS, et al. Practice guidelines for sedation and analgesia by non-anesthesiologists. Anesthesiology. 2002;96:1004–1017
  6. Conigliaro R, Rossi A. Implementation of sedation guidelines in clinical practice in Italy: results of a prospective longitudinal milticenter study. Endoscopy. 2006;38:1137–1143
  7. Pitetti R, Davis PJ, Redlinger R, White J, Wiener E, Calhoun KH. Effect on hospital-wide sedation practices after implementation of the 2001 JCAHO procedural sedation and analgesia guidelines. Arch Pediatr Adolesc Med. 2006;160:211–216
  8. Dripps RD, Lamont A, Eckenhoff JE. The role of anesthesia in surgical mortality. JAMA. 1961;178:261–266
  9. Warner MA, Caplan RA, Epstein BS, Gibbs CP, Keller CE, Leak JA, et al. Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: application to healthy patients undergoing elective procedures: a report by the American Society of Anesthesiologist Task Force on Preoperative Fasting. Anesthesiology. 1999;90:896–905
  10. Godwin SA, Caro DA, Wolf SJ, Jagoda AS, Charles R, Marett BE, et al. Clinical policy: procedural sedation and analgesia in the emergency department. Ann Emerg Med. 2005;45:177–196
  11. Langeron O, Masso E, Huraux C, Guggiari M, Bianchi A, Coriat P, et al. Prediction of difficult mask ventilation. Anesthesiology. 2000;92:1229–1236
  12. Mallampati SR, Gatt SP, Gugino LD, Desai SP, Waraksa B, Freiberger D, et al. A clinical sign to predict difficult tracheal intubation: a prospective study. Can Anaesth Soc J. 1985;32:429–434
  13. Pasternak LR, Arens JF, Caplan RA, Connis RT, Fleisher LA, Flowerdew R, et al. Practice advisory for preanesthesia evaluation: a report by the American Society of Anesthesiologists task force on preanesthesia evaluation. Anesthesiology. 2002;96:485–496
  14. Qureshi WA, Adler DG, Davila RE, Hirota WK, Jacobson BC, et al. ASGE guideline: guidelines for endoscopy in pregnant and lactating women. Gastrointest Endosc. 2005;61:357–362
  15. Joint Commission on Accreditation of Healthcare Organizations. Comprehensive accreditation manual for hospitals: the official handbook of the JCAHO. Oakbrook Terrace, IL: Joint Commission on Accreditation of Healthcare Organizations; 2005;
  16. Chung F, Chan V, Ong D. A post anesthetic discharge scoring system for home readiness after ambulatory surgery. J Clin Anesth. 1995;7:500–506
  17. Kohn LT, Corrigan JM, Donaldson MS. To err is human: building a safer health care system. Washington, DC: National Academy Press; 2000;
  18. American Society for Gastrointestinal Endoscopy. Guidelines for training in patient monitoring and sedation and analgesia. Gastrointest Endosc. 1998;48:669–671
  19. Omoigui S. The anesthesia drugs handbook. 2nd ed.. St. Louis: Mosby; 1995;
  20. Physician’s drug handbook. 11th ed.. Philadelphia: Lippincott, Williams, Wilkins; 2005;
  21. Mather LE, Tucker GT, Pflug AE, Lindop MJ, Wilkerson C. Meperidine kinetics in man (Intravenous injection in surgical patients and volunteers). Clin Pharmacol Ther. 1975;17:21–30
  22. Donnelly MB, Scott WA, Daly DS. Sedation for upper gastrointestinal endoscopy: a comparison of alfentanil-midazolam and meperidine-diazepam. Can J Anaesth. 1994;41:1161–1165
  23. Bailey PL, Pace NL, Ashburn MA, Moll JW, East KA, Stanley TH. Frequent hypoxemia and apnea after sedation with midazolam and fentanyl. Anesthesiology. 1990;73:826–830
  24. Buck ML, Blumer JL. Opioids and other analgesics (Adverse effects in the intensive care unit). Crit Care Clin. 1991;7:615–637
  25. Stack CG, Rogers P, Linter SP. Monoamine oxidase inhibitors and anaesthesia (A review). Br J Anaesth. 1988;60:222–227
  26. Stephens MJ, Gibson PR, Jakobovits AW, Metz GL, Dudley FJ. Fentanyl and diazepam in endoscopy of the upper gastrointestinal tract. Med J Aust. 1982;1:419–420
  27. Arnot RS. Fentanyl in endoscopy of upper GI tract. Med J Aust. 1983;1:151
  28. Jasinski DR, Martin WR, Haertzen CA. The human pharmacology and abuse potential of N-allylnoroxymorphone (naloxone). J Pharmacol Exp Ther. 1967;157:420–426
  29. Reves JG, Fragen RJ, Vinik HR, Greenblatt DJ. Midazolam: pharmacology and uses. Anesthesiology. 1985;62:310–324
  30. Kanto JH. Midazolam: the first water-soluble benzodiazepine (Pharmacology, pharmacokinetics and efficacy in insomnia and anesthesia). Pharmacotherapy. 1985;5:138–155
  31. Greenblatt DJ, Abernethy DR. Midazolam pharmacology and pharmacokinetics. Anesth Rev. 1985;12:17–20
  32. Nordt SP, Clark RF. Midazolam: a review of therapeutic uses and toxicity. J Emerg Med. 1997;15:357–365
  33. Robb ND, Hargrave SA. Tolerance to intravenous midazolam as a result of oral benzodiazepine therapy: a potential problem for the provision of conscious sedation in dentistry. Anesth Pain Control Dent. 1993;2:94–97
  34. Cole SG, Brozinsky S, Isenberg JI. Midazolam, a new more potent benzodiazepine, compared with diazepam: a randomized, double-blind study of preendoscopic sedatives. Gastrointest Endosc. 1983;29:219–222
  35. Lee MG, Hanna W, Harding H. Sedation for upper gastrointestinal endoscopy: a comparative study of midazolam and diazepam. Gastrointest Endosc. 1989;35:82–84
  36. Classen DC, Pestotnik SL, Evans RS, Burke JP. Intensive surveillance of midazolam use in hospitalized patients and the occurrence of cardiorespiratory arrest. Pharmacotherapy. 1992;12:213–216
  37. Arcos GJ. Midazolam-induced ventricular irritability (letter). Anesthesiology. 1987;67:612
  38. Fiset L, Milgrom P, Beirne OR, Roy-Byrne P. Disinhibition of behaviors with midazolam: report of a case. J Oral Maxillofac Surg. 1992;50:645–649
  39. Mora CT, Torjman M, White PF. Sedative and ventilatory effects of midazolam infusion: effect of flumazenil reversal. Can J Anaesth. 1995;42:677–684
  40. Gross JB, Blouin RT, Zandberg S, Conard P, Jurgen H. Effect of flumazenil on ventilatory drive during sedation with midazolam and alfentanil. Anesthesiology. 1996;85:713–720
  41. Carter AS, Bell GD, Coady T, Lee J, Morden AE. Speed of reversal of diazepam-induced respiratory depression by flumazenil—a study in patients undergoing upper GI endoscopy. Acta Anaesthesiol Scand. 1990;92(Suppl):59–64
  42. Spinelli P, Pacilli P, Sicignano A. Clinical use of flumazenil (Ro 15-1788) after endoscopic procedures (abstr). Endoscopy. 1988;20:86
  43. Andrews PJ, Wright DJ, Lamont MC. Flumazenil in the outpatient (A study following midazolam as sedation for upper gastrointestinal endoscopy). Anaesthesia. 1990;45:445–448
  44. Bartelsman JF, Sars PR, Tytgat GN. Flumazenil used for reversal of midazolam-induced sedation in endoscopy outpatients. Gastrointest Endosc. 1990;36(Suppl):S9–S12
  45. Waring JP, Baron TH, Hirota WK, Goldstein JL, Jacobson BC, Leighton JA, et al. Guidelines for conscious sedation and monitoring during gastrointestinal endoscopy. Gastrointest Endosc. 2003;58:317–322
  46. Chang AC, Solinger MA, Yang DT, Chen YK. Impact of flumazenil on recovery after outpatient endoscopy: a placebo-controlled trial. Gastrointest Endosc. 1999;49:573–579
  47. Kankaria A, Lewis JH, Ginsberg G, Gallagher J, al Kawas FH, Nguyen CC, et al. Flumazenil reversal of psychomotor impairment due to midazolam or diazepam for conscious sedation for upper endoscopy. Gastrointest Endosc. 1996;44:416–421
  48. Wille RT, Chaffee BW, Ryan ML, Elta GH, Walter V, Barnett JL. Pharmacoeconomic evaluation of flumazenil for routine outpatient EGD. Gastrointest Endosc. 2000;51:282–287
  49. Alarcon FO, Baudet Arteaga JS, Sanchez DR, Moreno SM, Martin Martin JM, Borque BP, et al. Utility of routine use of reversion after sedation in outpatient colonoscopy. Gastroenterol Hepatol. 2005;28:10–14
  50. Mordel A, Winkler E, Almog S, Tirosh M, Ezra D. Seizures after flumazenil administration in a case of combined benzodiazepine and tricyclic antidepressant overdose. Crit Care Med. 1992;20:1733–1734
  51. Mackenzie N, Grant IS. Propofol for intravenous sedation. Anaesthesia. 1987;42:3–6
  52. Hara M, Kai Y, Ikemoto Y. Propofol activates GABA A receptor-chloride ionophore complex in dissociated hippocampal pyramidal neurons of the rat. Anesthesiology. 1993;79:781–788
  53. Morcos WE, Payne JP. The induction of anaesthesia with propofol (Diprivan) compared in normal and renal failure patients. Postgrad Med J. 1985;61(Suppl 3):62–63
  54. Thomas VL, Sutton DN, Saunders DA. The effect of fentanyl on propofol requirements for day case anaesthesia. Anaesthesia. 1988;43(Suppl):73–75
  55. Bryson HM, Fulton BR, Faulds D. Propofol (An update of its use in anaesthesia and conscious sedation). Drugs. 1995;50:513–559
  56. White PF. Propofol pharmacokinetics and pharmacodynamics. Semin Anesth. 1988;7:4–20
  57. Stark RD, Binks SM, Dutka VN, O’Connor KM, Arnstein MJ, Glen JB. A review of the safety and tolerance of propofol (Diprivan). Postgrad Med J. 1985;61(Suppl 3):152–156
  58. Gan TJ, Glass PS. Balanced anesthesia. In:  White PF editors. Textbook of intravenous anesthesia. Baltimore: Williams & Wilkins; 1997;p. 347–374
  59. Short TG, Plummer JL, Chui PT. Hypnotic and anaesthetic interactions between midazolam, propofol and alfentanil. Br J Anaesth. 1992;69:162–167
  60. Rex DK, Heuss LT, Walker JA, Qi R. Trained registered nurses/endoscopy teams can administer propofol safely for endoscopy. Gastroenterology. 2005;129:1384–1391
  61. Clarke AC, Chiragakis L, Hillman LC, Kaye GL. Sedation for endoscopy: the safe use of propofol by general practitioner sedationists. Med J Aust. 2002;176:158–161
  62. Heuss LT, Schnieper P, Drewe J, Pflimlin E, Beglinger C. Safety of propofol for conscious sedation during endoscopic procedures in high-risk patients—a prospective, controlled study. Am J Gastroenterol. 2003;98:1751–1757
  63. Byrne MF, Baillie J. Nurse-assisted propofol sedation: the jury is in!. Gastroenterology. 2005;129:1781–1782
  64. Joint Statement of a Working Group from the American College of Gastroenterology (ACG), the American Gastroenterological Association (AGA), and the American Society for Gastrointestinal Endoscopy (ASGE). Recommendations on the administration of sedation for the performance of endoscopic procedures. Available at: http://www.gastro.org/wmspage.cfm?parm1=371. Accessed August 14, 2006.
  65. Rex DK, Overley C, Kinser K, Coates M, Lee A, Goodwine BW, et al. Safety of propofol administered by registered nurses with gastroenterologist supervision in 2000 endoscopic cases. Am J Gastroenterol. 2002;97:1159–1163
  66. Walker JA, McIntyre RD, Schleinitz PF, Jacobson KN, Haulk AA, Adesman P, et al. Nurse-administered propofol sedation without anesthesia specialists in 9152 endoscopic cases in an ambulatory surgery center. Am J Gastroenterol. 2003;98:1744–1750
  67. Heuss LT, Schnieper P, Drewe J, Pflimlin E, Beglinger C. Risk stratification and safe administration of propofol by registered nurses supervised by the gastroenterologist: a prospective observational study of more than 2000 cases. Gastrointest Endosc. 2003;57:664–671
  68. Wehrmann T, Kokabpick S, Lembcke B, Caspary WF, Seifert H. Efficacy and safety of intravenous propofol sedation during routine ERCP: a prospective, controlled study. Gastrointest Endosc. 1999;49:677–683
  69. Tohda G, Higashi S, Wakahara S, Morikawa M, Sakumoto H, Kane T. Propofol sedation during endoscopic procedures: safe and effective administration by registered nurses supervised by endoscopists. Endoscopy. 2006;38:360–367
  70. Kern SE, Xie G, White JL, Egan TD. A response surface analysis of propofol-remifentanil pharmacodynamic interaction in volunteers. Anesthesiology. 2004;100:1373–1381
  71. Cohen LB, Hightower CD, Wood DA, Miller KM, Aisenberg J. Moderate level sedation during endoscopy: a prospective study using low-dose propofol, meperidine/fentanyl, and midazolam. Gastrointest Endosc. 2004;59:795–803
  72. Koshy G, Nair S, Norkus EP, Hertan HI, Pitchumoni CS. Propofol versus midazolam and meperidine for conscious sedation in GI endoscopy. Am J Gastroenterol. 2000;95:1476–1479
  73. Cohen LB, Dubovsky AN, Aisenberg J, Miller KM. Propofol for endoscopic sedation: a protocol for safe and effective administration by the gastroenterologist. Gastrointest Endosc. 2003;58:725–732
  74. Rudner R, Jalowiecki P, Kawecki P, Gonciarz M, Mularczyk A, Petelenz M. Conscious analgesia/sedation with remifentanil and propofol versus total intravenous anesthesia with fentanyl, midazolam, and propofol for outpatient colonoscopy. Gastrointest Endosc. 2003;57:657–663
  75. Vargo JJ, Zuccaro G, Dumot JA, Shermock KM, Morrow JB, Conwell DL, et al. Gastroenterologist-administered propofol versus meperidine and midazolam for advanced upper endoscopy: a prospective, randomized trial. Gastroenterology. 2002;123:8–16
  76. Sipe BW, Rex DK, Latinovich D, Overley C, Kinser K, Bratcher L, et al. Propofol versus midazolam/meperidine for outpatient colonoscopy: administration by nurses supervised by endoscopists. Gastrointest Endosc. 2002;55:815–825
  77. Ulmer BJ, Hansen JJ, Overley CA, Symms MR, Chadalawada V, Liangpunsakul S, et al. Propofol versus midazolam/fentanyl for outpatient colonoscopy: administration by nurses supervised by endoscopists. Clin Gastroenterol Hepatol. 2003;1:425–432
  78. Paspatis GA, Manolaraki M, Xirouchakis G, Papanikolaou N, Chlouverakis G, Gritzali A. Synergistic sedation with midazolam and propofol versus midazolam and pethidine in colonoscopies: a prospective, randomized study. Am J Gastroenterol. 2002;97:1963–1967
  79. Reimann FM, Samson U, Derad I, Fuchs M, Schiefer B, Stange EF. Synergistic sedation with low-dose midazolam and propofol for colonoscopies. Endoscopy. 2000;32:239–244
  80. Qadeer MA, Vargo JJ, Khandwala F, Lopez R, Zuccaro G. Propofol versus traditional sedative agents for gastrointestinal endoscopy: a meta-analysis. Clin Gastroenterol Hepatol. 2005;3:1049–1056
  81. Durrani Z, Winnie AP, Zsigmond EK, Burnett ML. Ketamine for intravenous regional anesthesia. Anesth Analg. 1989;68:328–332
  82. Green SM, Li J. Ketamine in adults: what emergency physicians need to know about patient selection and emergence reactions. Acad Emerg Med. 2000;7:278–281
  83. Green SM, Clark R, Hostetler MA, Cohen M, Carlson D, Rothrock SG. Inadvertent ketamine overdose in children: clinical manifestations and outcome. Ann Emerg Med. 1999;34:492–497
  84. Gilger MA, Spearman RS, Dietrich CL, Spearman G, Wilsey MJ, Zayat MN. Safety and effectiveness of ketamine as a sedative agent for pediatric GI endoscopy. Gastrointest Endosc. 2004;59:659–663
  85. Aggarwal A, Ganguly S, Anand VK, Patwari AK. Efficacy and safety of intravenous ketamine for sedation and analgesia during pediatric endoscopic procedures. Indian Pediatr. 1998;35:1211–1214
  86. Kirberg A, Sagredo R, Montalva G, Flores E. Ketamine for pediatric endoscopic procedures and as a sedation complement for adult patients. Gastrointest Endosc. 2005;61:501–502
  87. White PF, Way WL, Trevor AJ. Ketamine—its pharmacology and therapeutic uses. Anesthesiology. 1982;56:119–136
  88. Saunders BP, Fukumoto M, Halligan S, Masaki T, Love S, Williams CB. Patient-administered nitrous oxide/oxygen inhalation provides effective sedation and analgesia for colonoscopy. Gastrointest Endosc. 1994;40:418–421
  89. Forbes GM, Collins BJ. Nitrous oxide for colonoscopy: a randomized controlled study. Gastrointest Endosc. 2000;51:271–277
  90. Maslekar SK, Hughes M, Skinn E, Gardiner A, Culbert B, Duthie GS. Randomised controlled trial of sedation for colonoscopy: entonox versus intravenous sedation (abstr). Gastrointest Endosc. 2006;63:AB97
  91. Gronert GA. Malignant hyperthermia. Anesthesiology. 1980;53:395–423
  92. Gronert GA, Pessah IN, Muldoon SM, Tautz TJ. Malignant hyperthermia. In:  Miller RD editors. Miller’s anesthesia. Philadelphia: Elsevier Churchill Livingstone; 2005;p. 1169–1190
  93. Hall JE, Uhrich TD, Barney JA, Arain SR, Ebert TJ. Sedative, amnestic, and analgesic properties of small-dose dexmedetomidine infusions. Anesth Analg. 2000;90:699–705
  94. Belleville JP, Ward D, Bloor BC, Maze M. Effects of intravenous dexmedetomidine in humans. I. Sedation, ventilation, and metabolic rate. Anesthesiology. 1992;77:1125–1133
  95. Aho M, Erkola O, Kallio A, Scheinin H, Korttila K. Comparison of dexmedetomidine and midazolam sedation and antagonism of dexmedetomidine with atipamezole. J Clin Anesth. 1993;5:194–203
  96. Martin E, Lebott JJ, Manikis P. Dexmedetomidine: a novel agent for patients in the intensive care setting (abstr). Intensive Care Med. 1999;25(Suppl):A623
  97. Bhana N, Goa KL, McClellan KJ. Dexmedetomidine. Drugs. 2000;59:263–268
  98. Jalowiecki P, Rudner R, Gonciarz M, Kawecki P, Petelenz M, Dziurdzik P. Sole use of dexmedetomidine has limited utility for conscious sedation during outpatient colonoscopy. Anesthesiology. 2005;103:269–273
  99. Drummond G. Dexmedetomidine may be effective, but is it safe?. Br J Anaesth. 2002;88:454–455
  100. Szabadi E, Bradshaw CM, Freeman C, Scaife J, Hou RH, Langley RW. The histaminergic system of the brain: its roles in arousal and autonomic regulation. Neuropsychopharmacol Hung. 2004;6:163–164
  101. Babenco HD, Blouin RT, Conard P, Gross JB. Diphenhydramine increases ventilatory drive during alfentanil infusion. Anesthesiology. 1998;89:642–647
  102. Tu RH, Grewall P, Leung JW, Suryaprasad AG, Sheykhzadeh PI, Doan C, et al. Diphenhydramine as an adjunct to sedation for colonoscopy: a double-blind randomized, placebo-controlled study. Gastrointest Endosc. 2006;63:87–94
  103. Basu R, Dodge H, Stoehr GP, Ganguli M. Sedative-hypnotic use of diphenhydramine in a rural, older adult, community-based cohort: effects on cognition. Am J Geriatr Psychiatry. 2003;11:205–213
  104. Campbell RL, Ross GA, Campbell JR, Mourino AP. Comparison of oral chloral hydrate with intramuscular ketamine, meperidine, and promethazine for pediatric sedation—preliminary report. Anesth Prog. 1998;45:46–50
  105. Moser JD, Caldwell JB, Rhule FJ. No more than necessary: safety and efficacy of low-dose promethazine. Ann Pharmacother. 2006;40:45–48
  106. Findlay CW. The value of promethazine hydrochloride in preparing patients for peroral endoscopy. Am Rev Respir Dis. 1962;86:272–274
  107. Watcha MF, White PF. New antiemetic drugs. Int Anesthesiol Clin. 1995;33:1–20
  108. Cohen J, Haber GB, Dorai JA, Schneider DM, Kandel GP, Kortan PP, et al. A randomized double-blind study of the use of droperidol for conscious sedation during therapeutic endoscopy in difficult to sedate patients. Gastrointest Endosc. 2000;51:546–551
  109. Wilcox CM, Forsmark CE, Cello JP. Utility of droperidol for conscious sedation in gastrointestinal endoscopic procedures. Gastrointest Endosc. 1990;36:112–115
  110. Willie RT, Barnett JL, Chey WD, et al. Routine droperidol premedication improves sedation for ERCP. Gastrointest Endosc. 2000;52:362–366
  111. Cressman WA, Plostnieks J, Johnson PC. Absorption, metabolism and excretion of droperidol by human subjects following intramuscular and intravenous administration. Anesthesiology. 1973;38:363–369
  112. Lebrun HI. Neurleptanalgesia in upper alimentary endoscopy. Gut. 1976;17:655–658
  113. Rozen P, Ratan J, Gilat T. Fentanyl, droperidol neuroleptanalgesia in gastrointestinal endoscopy. Gastrointest Endosc. 1977;23:142–144
  114. Gan TJ. ”Black box” warning on droperidol: report of the FDA convened expert panel. Anesth Analg. 2004;98:1809
  115. Young D. FDA advisory panel discusses droperidol concerns. Am J Health Syst Pharm. 2004;61:219–222
  116. Cote CJ, Wilson S, Casamassimo P, Crumrine P, Gorman RL, Hegenbarth M. Guidelines for monitoring and management of pediatric patients during and after sedation for diagnostic and therapeutic procedures: an update. Pediatrics. 2006;118:2587–2602
  117. Chernik DA, Gillings D, Laine H, Hendler J, Silver JM, Davidson AB, et al. Validity and reliability of the Observer’s Assessment of Alertness/Sedation Scale: study with intravenous midazolam. J Clin Psychopharmacol. 1990;10:244–251
  118. Ramsay M, Savege T, Simpson B. Controlled sedation with alphaxalone-alphadolone. BMJ. 1974;ii:656–659
  119. Riker RR, Picard JT, Fraser GL. Prospective evaluation of the sedation-agitation scale for adult critically ill patients. Crit Care Med. 1999;27:1325–1329
  120. Poirier MP, Gonzalez Del-Rey JA, McAneney CM, Digiulio GA. Utility of monitoring capnography, pulse oximetry, and vital signs in the detection of airway mishaps: a hyperoxemic animal model. Am J Emerg Med. 1998;16:350–352
  121. Vargo JJ, Zuccaro G, Dumot JA, Conwell DL, Morrow JB, Shay SS. Automated graphic assessment of respiratory activity is superior to pulse oximetry and visual assessment for the detection of early respiratory depression during therapeutic upper endoscopy. Gastrointest Endosc. 2002;55:826–831
  122. Lightdale JR, Goldmann DA, Feldman HA, Newburg AR, DiNardo JA, Fox VL. Microstream capnography improves patient monitoring during moderate sedation: a randomized, controlled trial. Pediatrics. 2006;117:e1170–e1178
  123. Burton JH, Harrah JD, Germann CA, Dillon DC. Does end-tidal carbon monoxide monitoring detect respiratory events prior to current sedation monitoring practices?. Acad Emerg Med. 2006;13:500–504
  124. Rosow C, Manberg PJ. Bispectral index monitoring. Anesthesiol Clin North America. 2001;19:947–966
  125. Overly FL, Wright RO, Connor FA, et al. Bispectral analysis during pediatric procedural sedation. Pediatr Emerg Care. 2005;21:6–11
  126. McDermott NB, VanSickle T, Motas D, Friesen RH. Validation of the bispectral index monitor during conscious and deep sedation in children. Anesth Analg. 2003;97:39–43
  127. Agrawal D, Feldman HA, Krauss B, Waltzman ML. Bispectral index monitoring quantifies depth of sedation during emergency department procedural sedation and analgesia in children. Ann Emerg Med. 2004;43:247–255
  128. Bower AL, Ripepi A, Dilger J, Boparai N, Brody FJ, Ponsky JL. Bispectral index monitoring of sedation during endoscopy. Gastrointest Endosc. 2000;52:192–196
  129. Bell JK, Laasch HU, Wilbraham L, England RE, Morris JA, Martin DF. Bispectral index monitoring for conscious sedation in intervention: better, safer, faster. Clin Radiol. 2004;59:1106–1113
  130. Drake LM, Chen SC, Rex DK. Efficacy of bispectral monitoring as an adjunct to nurse-administered propofol sedation for colonoscopy: a randomized controlled trial. Am J Gastroenterol. 2006;101:2003–2007
  131. Bailey PL, Zuccaro G. Sedation for endoscopic procedures: not as simple as it seems. Am J Gastroenterol. 2006;101:2008–2010
  132. Miner JR, Heegaard W, Plummer D. End-tidal carbon dioxide monitoring during procedural sedation. Acad Emerg Med. 2002;9:275–280
  133. Rubin DM, Eisig S, Freeman C, Kraut RA. Effect of supplemental gases on end-tidal CO2 and oxygen saturation in patients undergoing fentanyl and midazolam outpatient sedation. Anesth Prog. 1997;44:1–4
  134. Downs JB. Has oxygen administration delayed appropriate respiratory care? (Fallacies regarding oxygen therapy). Respir Care. 2003;48:611–620
  135. Fu ES, Downs JB, Schweiger JW, Miguel RV, Smith RA. Supplemental oxygen impairs detection of hypoventilation by pulse oximetry. Chest. 2004;126:1552–1558
  136. Farnsworth ST, Egan TD, Johnson SE, Westenskow D. Teaching sedation and analgesia with simulation. J Clin Monit. 2000;16:273–285
  137. Rall M, Gaba D. Patient simulators. In:  Miller RD editors. Miller’s anesthesia. Philadelphia: Elsevier, Churchill Livingstone; 2005;p. 3073–3103
  138. Chutkan R, Cohen J, Abedi M, Cruz-Correa M, Dominitz J, Gersin K, et al. Training guideline for use of propofol in gastrointestinal endoscopy. Gastrointest Endosc. 2004;60:167–172
  139. Petrini J, Feld A, Gerstenberger P, Greene M, Ryan M. Risk management for the endoscopist. American Society for Gastrointestinal Endoscopy, 2006. Available at: http://www.asge.org/nspages/practice/management/establishing/risk.cfm. Accessed October 29, 2006.
  140. Gerstenberger PD, Plumeri PA. Malpractice claims in gastrointestinal endoscopy: analysis of an insurance industry data base. Gastrointest Endosc. 1993;39:132–138
  141. Petrini J, Egan JV. Risk management regarding sedation/analgesia. Gastrointest Endosc Clin N Am. 2004;14:401–414
  142. Aisenberg J. Who should sedate our patients? A gastroenterologist’s perspective. Paper presented at Endoscopic Sedation: Preparing for the Future. November 5, 2005. New York.
  143. President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research. US Code Annot US 1982; Title 42 Sect 300v 1978. Publication type: Legislation PMID:12041401.
  144. Anesthetists for the safe administration of propofol, 2006. Available at: http://safepropofol.org. Accessed: July 10, 2006.
  145. Propofol injectable emulsion 1%. Package insert. Deerfield, IL: Baxter Healthcare Corporation; September 2004 revision, p 18. Available at: http://www.baxter.com/products/anesthesia/anesthetic/pharmaceuticals/downloads/propofol.pdf. Accessed June 25, 2006.
  146. Levine EG, Brandt LJ, Plumeri P. Informed consent: a survey of physician outcomes and practices. Gastrointest Endosc. 1995;41:448–452
  147. Bhananker SM, Posner KL, Cheney FW, Caplan RA, Lee LA, Domino KB. Injury and liability associated with monitored anesthesia care: a closed claims analysis. Anesthesiology. 2006;104:228–234
  148. Staff DM, Saeian K, Rochling F, Narayanan S, Kern M, Shaker R, et al. Does open access endoscopy close the door to an adequately informed patient?. Gastrointest Endosc. 2000;52:212–217
  149. Informed Consent. American Medical Association (Legal Issues). American Medical Association, Office of the General Counsel, Division of Health Law. 1998 AMA. Posted September 1998. Last updated March 7, 2005. Available at: http://www.ama-assn.org/ama/pub/category/print/4608.html. Accessed January 17, 2007.
  150. Brooks AJ, Hurlstone DP, Fotheringham J, Gane J, Sanders DS, McAlindon ME. Information required to provide informed consent for endoscopy: an observational study of patients’ expectations. Endoscopy. 2005;37:1136–1139
  151. Noah L. Informed consent and the elusive dichotomy between standard and experimental therapy. Am J Law Med. 2002;28:361–408
  152. Informed consent for gastrointestinal endoscopy. Gastrointest Endosc. 1988;34(Suppl):26S–27S
  153. Lawrence VE. Drug manufacturers’ recommendations and the common knowledge rule to establish medical malpractice. Nebraska Law Review. 1984;63:859
  154. Levinson W, Roter DL, Mullooly JP, Dull VT, Frankel RM. Physician-patient communication (The relationship with malpractice claims among primary care physicians and surgeons). JAMA. 1997;277:553–559
  155. Pereira SP, Hussaini SH, Wilkinson ML. Informed consent for upper gastrointestinal endoscopy. Gut. 1995;37:151–153
  156. Proctor DD, Price J, Minhas BS, Gumber SC, Christie EM. Patient recall and appropriate timing for obtaining informed consent for endoscopic procedures. Am J Gastroenterol. 1999;94:967–971
  157. Elfant AB, Korn C, Mendez L, Pello MJ, Peikin SR. Recall of informed consent after endoscopic procedures. Dis Colon Rectum. 1995;38:1–3
  158. Braddock CH, Fihn SD, Levinson W, Jonson AR, Pearlman RA. How doctors and patients discuss routine clinical decisions: informed decision making in the outpatient setting. J Gen Intern Med. 1997;12:339–345
  159. Bell GD, Neale G, Wilkinson M, Tanner A, Campbell D, Botrill P, et al. Guidelines for informed consent for endoscopic procedures. British Society of Gastroenterology. 1999. Available at: http://www.bsg.org.uk/bsgdisp1.php?id=bc848b9f4522d7808561&h=1&sh=1&i=1&b=1&m=00023. Accessed June 25, 2006.
  160. Mayberry MK, Mayberry JF. Towards better informed consent in endoscopy: a study of information and consent processes in gastroscopy and flexible sigmoidoscopy. Eur J Gastroenterol Hepatol. 2001;13:1467–1476
  161. Obtaining informed consent. Joint Commission Resources. Available at: http://www.jcrinc.com/10411/. Accessed June 25, 2007.
  162. Keglovitz LA, Kraft M. Chapter 1: Evaluating the patient before anesthesia. In:  Hurford WE,  Bailin MT,  Davidson JK,  Haspel KL,  Rosow C editor. Clinical Anesthesia Procedures of the Massachusetts General Hospital. 5th ed.. Philadelphia: Lippincott Williams & Wilkins; 1998;p. 10
  163. Parera de Cáceres A, González AC, Menchén Fernández-Pacheco PL, Senent SC, Jiménez AP, Vaquero MJ, et al. Survey of informed consent in a gastrointestinal endoscopy unit. Article in Spanish Gastroenterol Hepatol. 2000;23:317–321
  164. Faigel D, Eisen G, Baron TH, Dominitz J, Goldstein JL, Hirota WK, et al. Preparation of patients for GI endoscopy. Gastrointest Endosc. 2003;57:446–450
  165. Sanford S. Informed consent: The verdict is in. ASA Newsletter. Vol 70. Number 7. July 2006. Available at: http://www.asahq.org/Newsletters/2006/07-06/sanford07_06.html. Accessed December 5, 2006.
  166. Aisenberg J, Piorkowski J, Cohen LB. Propofol use under the direction of trained gastroenterologists—an analysis of the medicolegal implications. Am J Gastroenterol. 2007;101:707–713
  167. Gibiansky E, Struys MM, Gibiansky L, Vanluchene AL, Vornov J, Mortier EP, et al. Aquavan injection, a water-soluble prodrug of propofol, as a bolus injection: a phase I dose-escalation comparison with diprivan (part 1) (Pharmacokinetics). Anesthesiology. 2005;103:718–729
  168. Struys MM, Vanluchene AL, Gibiansky E, Gibiansky L, Vornov J, Mortier EP, et al. Aquavan injection, a water-soluble prodrug of propofol as a bolus injection: a phase I dose-escalation comparison with diprivan (part 2) (Pharmacodynamics and safety). Anesthesiology. 2005;103:730–743
  169. Cohen LB, Wang C, Jones JB. AQUAVAN is safe and effective for minimal to moderate sedation during colonoscopy. Anesthesiology. 2006;105:A1367
  170. Kulling D, Fantin AC, Biro P, Bauerfeind P, Fried M. Safer colonoscopy with patient-controlled analgesia and sedation with propofol and alfentanil. Gastrointest Endosc. 2001;54:1–7
  171. Roseveare C, Seavell C, Patel P, Criswell J, Kimble J, Jones C, et al. Patient-controlled sedation and analgesia, using propofol and alfentanil, during colonoscopy: a prospective randomized controlled trial. Endoscopy. 1998;30:768–773
  172. Lee DW, Chan AC, Wong SK, Li AC, Sze TS, Chung SC. The safety, feasibility, and acceptability of patient-controlled sedation for colonoscopy: prospective study. Hong Kong Med J. 2004;10:84–88
  173. Bright E, Roseveare C, Dalgleish D, Kimble J, Elliott J, Shepherd H. Patient-controlled sedation for colonoscopy: a randomized trial comparing patient-controlled administration of propofol and alfentanil with physician-administered midazolam and pethidine. Endoscopy. 2003;35:683–687
  174. Heuss LT, Drewe J, Schnieper P, Tapparelli CB, Pflimlin E, Beglinger C. Patient-controlled versus nurse-administered sedation with propofol during colonoscopy (A prospective randomized trial). Am J Gastroenterol. 2004;99:511–518
  175. Heiman DR, Tolliver BA, Weis FR, O’Brien BL, DiPalma JA. Patient-controlled anesthesia for colonoscopy using propofol: results of a pilot study. South Med J. 1998;91:560–564
  176. Jowell PS, Eisen G, Onken J, Bute BP, Ginsberg B. Patient-controlled analgesia for conscious sedation during endoscopic retrograde cholangiopancreatography: a randomized controlled trial. Gastrointest Endosc. 1996;43:490–494
  177. Egan TD. Target-controlled drug delivery: progress toward an intravenous “vaporizer” and automated anesthetic administration. Anesthesiology. 2003;99:1214–1219
  178. Fanti L, Agostoni M, Casati A, Guslandi M, Giollo P, Torri G, et al. Target-controlled propofol infusion during monitored anesthesia in patients undergoing ERCP. Gastrointest Endosc. 2004;60:361–366
  179. Gillham MJ, Hutchinson RC, Carter R, Kenny GN. Patient-maintained sedation for ERCP with a target-controlled infusion of propofol: a pilot study. Gastrointest Endosc. 2001;54:14–17
  180. Campbell L, Imrie G, Doherty P, Porteous C, Millar K, Kenny GN, et al. Patient maintained sedation for colonoscopy using a target controlled infusion of propofol. Anaesthesia. 2004;59:127–132
  181. Leslie K, Absalom A, Kenny GN. Closed loop control of sedation for colonoscopy using the bispectral index. Anaesthesia. 2002;57:693–697
  182. Stonell CA, Leslie K, Absalom AR. Effect-site targeted patient-controlled sedation with propofol: comparison with anaesthetist administration for colonoscopy. Anaesthesia. 2006;61:240–247
  183. Doufas AG, Bakshandeh M, Bjorsten AR, Sahfer DI. Induction speed is not a determinant of propofol pharmacodynamics. Anesthesiology. 2004;101:1112–1121
  184. Pambianco DJ, McRorie J, Martin J, Politove R, Whitten CJ. Feasibility assessment of computer assisted personalized sedation: a sedation delivery system to administer propofol for gastrointestinal endoscopy (abstr). Gastrointest Endosc. 2006;63:AB189

 This literature review and the recommendations therein were prepared for the AGA Institute Clinical Practice and Economics Committee by the AGA Institute Sedation Subcommittee. The paper was approved by the Committee on April 26, 2007, and by the AGA Institute Governing Board on May 19, 2007.

PII: S0016-5085(07)01115-8

doi: 10.1053/j.gastro.2007.06.002

Gastroenterology
Volume 133, Issue 2 , Pages 675-701 , August 2007

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