What is sedation for endoscopy

Endoscopy today: usually sedation or short anesthesia

LUDWIGSHAFEN (sir). Most patients today receive sedation during an endoscopy. Propofol, a short-acting narcotic, is ideal for this because of its rapid onset of action and its short half-life. Monitoring should, however, be intensified.

Already 74 to 87 percent of endoscopy patients in Germany - depending on whether esophagogastroduodenoscopy or colonoscopy - are sedated. "But this carries a certain risk," emphasized Dr. Andrea Riphaus from Hanover.

Risk factors for cardiorespiratory events are primarily diseases of the heart, lungs, kidneys or liver and a poor general condition of the patient. Breathing problems known from anamnestic, cervical spine trauma or obesity are also warning signs.

According to Riphaus, sedation with propofol, a short-acting narcotic without analgesic effects, is "controversial".

The advantage: "The sedative effect of propofol begins and ends very quickly, it has a short half-life," said Riphaus at the Rhein-Neckar Forum for Gastroenterology and Hepatology in Ludwigshafen. "This shortens the wake-up and monitoring phase after the procedure."

Riphaus presented a study of 96 patients who underwent a driving simulator test after gastroscopy or colonoscopy with sedation. "In the case of more complex tasks, there was a clear advantage for patients with propofol sedation alone compared to patients with a combination of midazolam and pethidine", says the gastroenterologist at the Dr. Falk Pharma supported event.

One disadvantage: the risk of respiratory depression and a drop in blood pressure. Patients who are sedated with propofol are not given ventilator in the first place. However, in order to keep the risk of respiratory depression and drop in blood pressure low, additional monitoring measures are recommended: "In addition to the pulse oximetry usual for endoscopic interventions, automatic blood pressure monitoring should run with Propofol," said the gastroenterologist. Cardiac and blood pressure patients also required ECG monitoring.

If no anesthetist is available, a second internist has to do the sedation with propofol, says Riphaus. Alternatively, an anesthetist or intensive care doctor could initiate the short anesthesia, which would also remain "within call range" for emergencies.

After the initial phase, trained non-medical specialists can then administer Propofol under medical supervision. Such courses are currently being developed, said Riphaus. However, such a procedure is not appropriate for high-risk patients.