Sedation for endoscopic procedures: Treading a tightrope

Excerpt

Sedation in the non-operating room for endoscopic procedures has been on a progressive path since its inception in the 1980s. The primary goal of sedation during the performance of these procedures is aimed at providing anxiolysis, amnesia, and analgesia, thus enhancing the success rate of the procedure [1]. For diagnostic endoscopic or routine colonoscopic procedures, mild to moderate sedation using benzodiazepine-opioid combination (e.g. midazolam and fentanyl) has been effective [2]. However, for more complex and invasive procedures such as endoscopic retrograde cholangiopancreatography (ERCP), endoscopic ultrasound (EUS), and peroral endoscopic myotomy (POEM), a deeper level of sedation is desirable to ensure a calm, tranquil, and still patient [3]. The Ramsay Sedation Scale is commonly used to assess the level of sedation in these patients and a score of 3 or 4 is desirable for deep sedation [4]. In deep sedation, patients are not easily arousable, but respond to noxious stimuli and maintain essential functions such as cough reflexes, spontaneous breathing, and cardiovascular stability [5]. However, striking a balance between patient comfort and patient safety during deep sedation is a daunting task. …