Article Text
Abstract
In the UK, more than 2.5 million endoscopic procedures are carried out each year. Most are performed under conscious sedation with benzodiazepines and opioids administered by the endoscopist. However, in prolonged and complex procedures, this form of sedation may provide inadequate patient comfort or result in oversedation. As a result, this may have a negative impact on procedural success and patient outcome. In addition, there have been safety concerns on the high doses of benzodiazepines and opioids used particularly in prolonged and complex procedures such as endoscopic retrograde cholangiopancreatography. Diagnostic and therapeutic endoscopy has evolved rapidly over the past 5 years with advances in technical skills and equipment allowing interventions and procedural capabilities that are moving closer to minimally invasive endoscopic surgery. It is vital that safe and appropriate sedation practices follow the inevitable expansion of this portfolio to accommodate safe and high-quality clinical outcomes. This position statement outlines the current use of sedation in the UK and highlights the role for anaesthetist-led deep sedation practice with a focus on propofol sedation although the choice of sedative or anaesthetic agent is ultimately the choice of the anaesthetist. It outlines the indication for deep sedation and anaesthesia, patient selection and assessment and procedural details. It considers the setup for a deep sedation and anaesthesia list, including the equipment required, the environment, staffing and monitoring requirements. Considerations for different endoscopic procedures in both emergency and elective setting are also detailed. The role for training, audit, compliance and future developments are discussed.
- gastrointesinal endoscopy
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Footnotes
Contributors GW proposed this position statement on behalf of the BSG Endoscopy Committee, contributed in writing the content of the manuscript, reviewed the revisions and approved the final version. RS structured the manuscript, wrote the initial draft, made all the revisions and submitted the manuscript. DT assisted with the initial draft and all subsequent revisions and final draft and did referencing for the document. MN, ST-G and DSS contributed in writing the content of the manuscript and critically appraised subsequent versions and approved the final version. GS and SH critically appraised all versions and approved the final version. RJH contributed in writing the content of the manuscript and critically appraised subsequent versions and approved the final version. RS and GW are the guarantors of the manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests MN is the director of the National Safe Sedation course. ST-G: Olympus: honoraria and equipment loans Fujinon; Pentax- educational funds and equipment loans SH: Educational funds from Aquilant Endoscopy. GW: Advisory board and educational funds: Olympus, Boston Scientific, Cook Medical, Pentax Medical. RS, DT, DSS, GS and RJH have no competing interests.
Patient consent Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
Author note This position statement was reviewed and endorsed by the British Society of Gastroenterology (BSG), Joint Advisory Group (JAG) and Royal College of Anaesthetists (RcoA) Nov 2018.
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