This is the current release of the guideline.

This guideline updates previous versions: Waring JP, Baron TH, Hirota WK, Goldstein JL, Jacobson BC, Leighton JA, Mallery JS, Faigel DO. Guidelines for conscious sedation and monitoring during gastrointestinal endoscopy. Gastrointest Endosc 2003 Sep;58(3):317-22. [36 references]

Faigel DO, Baron TH, Goldstein JL, Hirota WK, Jacobson BC, Johanson JF, Leighton JA, Mallery JS, Peterson KA, Waring JP, Fanelli RD, Wheeler-Harbaugh J. Guidelines for the use of deep sedation and anesthesia for GI endoscopy. Gastrointest Endosc 2002 Nov;56(5):613-7. [23 references]

Definitions for the grades of recommendations (1A to 3) are given at the end of the "Major Recommendations" field.

1. Adequate and safe sedation can be achieved in most patients undergoing routine esophagogastroduodenoscopy and colonoscopy by using an intravenous benzodiazepine and opioid combination (1B).
2. In patients who are not adequately sedated with an intravenous benzodiazepine and opioid combination, the addition of other intravenous agents such as droperidol, promethazine, or diphenhydramine (Benadryl) may allow adequate and safe sedation to be achieved (1B).
3. Sedation providers must have a thorough understanding of medications used for endoscopic sedation and the skills necessary for the diagnosis and treatment of cardiopulmonary complications (3).
4. Noninvasive blood measurement and pulse oximetry are supplemental to-and do not replace- clinical observation of the patient during endoscopic sedation. Newer methods of monitoring are available but data to assess their impact on clinical outcomes is lacking, and their routine use for sedation must be individualized (2B).
5. During moderate sedation, the person assigned responsibility for patient assessment may also perform tasks that are interruptible and of short duration. When deep sedation is planned, this individual should be dedicated to observation and monitoring and have no other procedure-related responsibilities (3).
6. Extended monitoring techniques may provide sensitive measures of patient's ventilatory function (capnography) and level of sedation (bispectral [BIS] index monitoring); however, there is insufficient evidence in the literature to support the routine use of extended monitoring devices during moderate sedation. The American Society of Anesthesiologists (ASA) states that automated monitoring for apnea (capnography) should be considered for patients receiving deep sedation and for all patients in whom ventilatory function cannot be observed adequately (1B).
7. Propofol has the advantages of more rapid onset of action and shorter recovery time compared with traditional sedative regimens. However, clinically important benefits in average-risk patients undergoing upper endoscopy and colonoscopy have not been consistently demonstrated with regard to patient satisfaction and safety. Therefore, the routine use of propofol in average- risk patients cannot be endorsed (1B).
8. Propofol can be safely and effectively given by nonanesthesiology physicians and nurses provided they have undergone appropriate training and credentialing in administration and rescue from potential pulmonary and cardiovascular complications (1C).
9. A patient targeted for one level of sedation may become more deeply sedated than planned. Therefore, an individual administering sedation/analgesia should be trained to and possess the skills necessary to rescue a patient who has reached a level of sedation deeper than that intended. Thus, a physician targeting moderate sedation must be able to rescue a patient who is deeply sedated. Similarly, an ability to rescue a patient from general anesthesia is necessary when providing deep sedation (3).
10. The assistance of an anesthesia specialist should be considered for ASA physical status III, IV, and V patients. Other possible indications for involvement of an anesthesia professional during sedation include emergency endoscopic procedures, complex endoscopic procedures, and patients with a history of (1) adverse reaction to sedation, (2) inadequate response to moderate sedation, (3) anticipated intolerance of standard sedatives (e.g., alcohol or substance abuse), and (4) those at increased risk for sedation-related complications, such as patients with severe comorbidities or with anatomic variants predictive of increased risk for airway obstruction or difficult intubation (e.g., morbid obesity or sleep apnea) (3).
11. An anesthesia specialist is not cost-effective for average-risk patients undergoing routine upper and lower endoscopic procedures (3).

Definitions:

Adapted from Guyatt G, Sinclair J, Cook D, et al. Moving from evidence to action: grading recommendations—a qualitative approach. In: Guyatt G, Rennie D, editors. Users' guides to the medical literature. Chicago: AMA Press; 2002. p. 599-608.

None provided

The type of supporting evidence is identified and graded for each recommendation (see "Major Recommendations").

Not applicable: The guideline was not adapted from another source.

2003 (revised 2008 Nov)

American Society for Gastrointestinal Endoscopy - Medical Specialty Society

American Society for Gastrointestinal Endoscopy

Standards of Practice Committee

Committee Members: David R. Lichtenstein, MD; Sanjay Jagannath, MD; Todd H. Baron, MD, Chair; Michelle A. Anderson, MD; Subhas Banerjee, MD; Jason A. Dominitz, MD, MHS; Robert D. Fanelli, MD, SAGES Representative; S. Ian Gan, MD; M. Edwyn Harrison, MD; Steven O. Ikenberry, MD; Bo Shen, MD; Leslie Stewart, SGNA Representative; Khalid Khan, MD, NAPSGHAN Representative; John J. Vargo, MD, MPH

Not stated

This is the current release of the guideline.

This guideline updates previous versions: Waring JP, Baron TH, Hirota WK, Goldstein JL, Jacobson BC, Leighton JA, Mallery JS, Faigel DO. Guidelines for conscious sedation and monitoring during gastrointestinal endoscopy. Gastrointest Endosc 2003 Sep;58(3):317-22. [36 references]

Faigel DO, Baron TH, Goldstein JL, Hirota WK, Jacobson BC, Johanson JF, Leighton JA, Mallery JS, Peterson KA, Waring JP, Fanelli RD, Wheeler-Harbaugh J. Guidelines for the use of deep sedation and anesthesia for GI endoscopy. Gastrointest Endosc 2002 Nov;56(5):613-7. [23 references]

None available

None available

This NGC summary was completed by ECRI on April 15, 2004. The information was verified by the guideline developer on May 12, 2004. This summary was updated by ECRI on February 21, 2006 following the U.S. Food and Drug Administration (FDA) advisory on benzocaine sprays. This summary was updated by ECRI Institute on March 10, 2009, following the U.S. Food and Drug Administration advisory on Topical Anesthetics. This summary was updated by ECRI Institute on June 15, 2009.

This NGC summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions.