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PubMed2000

Deep sedation with inhaled sevoflurane for pediatric outpatient gastrointestinal endoscopy.

BACKGROUND: Sevoflurane is an inhaled anesthetic agent with ideal properties for achieving deep sedation during pediatric outpatient gastrointestinal endoscopy. This is a comparison of experience with this gas and other sedation methods used in the authors' hospital. METHODS: Retrospective chart review and statistical analysis of data from children receiving inhaled sevoflurane administered by an anesthesiologist through laryngeal insufflation, intravenous propofol, or intravenous midazolam-fentanyl-ketamine in any combination to achieve deep sedation for outpatient gastrointestinal endoscopy. Anesthesia was administered in a dedicated procedure room. The intravenous drugs were administered by pediatric intensivists in the intensive care unit. The same endoscopist performed all the procedures. RESULTS: A total of 248 procedures were reviewed (midazolam-fentanyl-ketamine 67, propofol 114, and sevoflurane 67). All patients were adequately sedated with sevoflurane, and no intravenous access was required. Time (in minutes) to awakening (midazolam-fentanyl-ketamine 47.15, propofol 36.12, sevoflurane 5.70), discharge (midazolam-fentanyl-ketamine 141.99, propofol 91.20, sevoflurane 53.34), and total time, including induction and procedure (midazolam-fentanyl-ketamine 163.97, propofol 119.40, sevoflurane 73.93), were significantly lower for sevoflurane (P < 0.01). The complication rate for sevoflurane (4.5%) was lower (P < 0.05) than for midazolam-fentanyl-ketamine (13.4%) and for propofol (17.5%). Charges for room use and medications were also lower for sevoflurane (P < 0.01). The total charges for sedation (U.S.$) were comparable for sevoflurane (688.10) and propofol (723.08) but were higher for midazolam-fentanyl-ketamine (855.10, P < 0.01). CONCLUSIONS: Deep sedation with inhaled sevoflurane for pediatric outpatient gastrointestinal endoscopy is as safe as conventional sedation techniques, potentially less expensive, increases endoscopy unit productivity, and eliminates the inconvenience associated with obtaining intravenous access in children.

Adolescent↗
PubMed2001

Accidental caustic ingestion in children: is endoscopy always mandatory?

BACKGROUND: Patients who have experienced severe caustic injury to the gastrointestinal tract are at high risk of esophageal strictures. Early endoscopy is usually recommended systematically in children after caustic ingestion to assess the severity of the initial digestive lesions. The aim of this study was to determine the predictive value of clinical symptoms and ingested-substance types as markers of severe esophagogastric lesions and to define indications for endoscopy. METHODS: Ingested-product types, clinical symptoms, endoscopic data and outcome were prospectively recorded in 85 children admitted after accidental caustic ingestion. RESULTS: Forty-eight children (57%) had no symptoms; the others presented with vomiting, hematemesis, drooling, respiratory distress, and/or oropharyngeal lesions. Endoscopy showed no or minimal lesions in 63 cases (74%). None of the children developed digestive sequelae. Severe esophagogastric lesions were present in 22 cases (26%), mostly caused by lye ingestion (14 of 22) but also by strong acids (4 of 22); 9 of the 22 children (41%) developed esophageal stenosis. Vomiting, drooling, and oropharyngeal lesions did not predict severe endoscopic lesions. Hematemesis, respiratory distress, or presence of at least three of the symptoms was associated with severe lesions (positive predictive value = 1). The absence of symptoms was always associated with no or minimal lesions (negative predictive value = 1). CONCLUSIONS: In conclusion, endoscopy is not recommended for children living in developed countries who are asymptomatic after accidental caustic ingestion.

Accidents, Home↗
PubMed2000

Eustachian tube endoscopy in patients with chronic ear disease.

OBJECTIVES/HYPOTHESIS: A paucity of research exists on trans-eustachian tube endoscopy to evaluate the status of the eustachian tube. Fuller examination of the role of the eustachian tube in chronic ear disease is needed, particularly because the eustachian tube has been implicated in the chronicity and pathogenesis of chronic ear disease. Therefore the purpose of this study was to evaluate the eustachian tube, based on observations from trans-eustachian tube endoscopy. STUDY DESIGN: Twenty-two adult patients with chronic ear disease gave informed consent to participate in a prospective, trans-eustachian tube endoscopic investigation. METHODS: Flexible, fiberoptic, nonarticulating (outside diameter of 0.5 mm) and articulating (outside diameter of 1.0 mm) endoscopes (coherent fused bundle of 3,000 pixels) were employed. The eustachian tube endoscopy was performed under general endotracheal anesthesia as the initial part of a larger, otological surgical procedure for chronic ear disease. The endoscope was passed from the middle ear (transtympanic approach) to the nasopharynx. RESULTS: The 0.5-mm endoscope passed entirely through the eustachian tube from the tympanic orifice into the pharyngeal orifice in 16% of the cases. Stenotic blockage occurred at the infundibulum in 37%, isthmus in 42%, and fossa of Rosenmuller in 5% of cases. The eustachian tube mucosa was abnormal in 64% of cases. The risk for abnormal eustachian tube mucosa was four times greater for persons with long-standing disease (> or = 20 y) than for persons without long-standing disease (<20 y). The mean therapeutic efficiency of ossicular reconstruction was higher for the subgroup with normal than for the subgroup with abnormal eustachian tube mucosa. CONCLUSIONS: The findings of trans-eustachian tube endoscopy provide objective evidence concerning eustachian tube status in persons with chronic ear disease and have implications for the timing of surgical intervention (ossicular reconstruction).

Adult↗
PubMed2001

Endoscopy-negative, computed tomography-negative facial pain in a nasal clinic.

OBJECTIVES: To establish the etiology of facial pain in individuals attending the nasal clinic of the Department of Otorhinolaryngology, University Hospital, Nottingham, U.K., with normal nasal endoscopy and computed tomography of the paranasal sinuses. STUDY DESIGN: A retrospective analysis of a cohort of 973 patients consecutively presenting to the nasal clinic with symptoms of rhinosinusitis and/or facial pain. METHODS: We reviewed the case notes of 973 consecutive patients who presented to the nasal clinic with either symptoms of rhinosinusitis or facial pain, and in particular 101 who had facial pain without any objective evidence of nasal disease as detected by nasal endoscopy or computed tomography. The diagnosis was based on the outcome and response to treatment after a mean of 2 years 2 months. RESULTS: One hundred one patients had pain as a predominant symptom with normal nasal endoscopy and computed tomography of the paranasal sinuses. None of these patients responded to either medical or surgical treatment for what some workers have hypothesized could be "occult" sinonasal disease. A neurological diagnosis was made in 99 patients. Eighty patients received successful medical treatment for "neurological" diagnoses, 8 patients experienced spontaneous resolution of their symptoms, 7 failed to respond to any treatment modality, 2 were lost to follow-up, and 2 refused any treatment. CONCLUSION: The majority of patients presenting to a rhinologic clinic with facial pain and no objective evidence of sinus disease, as detected by endoscopy and computed tomography, responded well to neurological treatment and surgical intervention was unnecessary. These patients should receive a trial of medical therapy, such as low-dose amitriptyline for 6 weeks in the first instance, before any surgical intervention is considered.

Endoscopy↗
PubMed2002

In vivo diagnosis of persistent and recurrent nasopharyngeal carcinoma by contact endoscopy.

OBJECTIVE: To evaluate the potential use of contact endoscopy for the diagnosis of persistent and recurrent nasopharyngeal carcinoma in postirradiated patients. STUDY DESIGN: Prospective study to examine 64 consecutive patients who have been irradiated for nasopharyngeal carcinoma in a clinic setting using contact rhinoscopes (Karl Storz, Tuttlingen, Germany [7215 AA, 0 degrees, and 7215 BA, 30 degrees; 23 cm long. 4 mm in diameter]). METHODS: The superficial cells of the posterior walls of the nasopharynx were stained with 1% methylene blue and examined with contact rhinoscopes with the patient under local anesthesia at high magnifications (x60 and x150). Biopsy of the areas under examination was performed. The contact endoscopic images were analyzed and correlated with the corresponding histological sections of the biopsy tissues. RESULTS: Contact endoscopy was performed in 64 patients (54 men; mean age, 42 y) with the use of local anesthesia. Four patterns of contact endoscopic findings were identified: squamous metaplasia (43 cases), postirradiation atypia (10), granulation tissue (6), and malignancy (5). In the last group, the nasopharynx appeared normal in two patients (40%). The findings of contact endoscopy correlated well with the histological findings (kappa reliability coefficient = 0.847; P <.001; diagnostic accuracy, 92.1%). For prediction of persistent and recurrent disease, the sensitivity and specificity of endoscopic findings were both 100%. CONCLUSION: Contact endoscopy is an accurate, reliable office-based procedure that allows for in vivo and in situ diagnosis of persistent and recurrent nasopharyngeal carcinoma in postirradiated patients.

Adult↗
PubMed1981

Evaluating the costs and benefits of a diagnostic technology: the case of upper gastrointestinal endoscopy.

Medical technology assessment has been proposed as a way to encourage more appropriate use of medical technologies, which may in turn lower medical care costs. The application to a diagnostic technology of techniques for medical technology assessment is discussed, using upper gastrointestinal endoscopy as an example. Several generic problems are often encountered when performing an assessment of a diagnostic technology. These problems include the need to weigh relatively concrete data on clinical and economic costs against less quantifiable data on the value of the information gained from the procedure. In the case of upper gastrointestinal endoscopy, data on morbidity (approximately two cases per 1,000 cases), mortality (approximately one case per 20,000 cases), changes (approximately +290 per procedure), and costs (between +69 and +128 per procedure) are relatively easily determined. Less easily calculated is the marginal diagnostic gain from endoscopies performed for the wide variety of conditions for which an endoscopy may be indicated. It is concluded that, in the case of diagnostic technologies, technology evaluations may be most useful as a heuristic tool. Because of the difficulty in weighing costs and benefits, however, formal evaluations of diagnostic technologies are not likely in the near future to contribute to medical care cost containment.

California↗
PubMed1992

Assigning appropriateness ratings for diagnostic upper gastrointestinal endoscopy using two different approaches.

Methods that combine information in the medical literature with expert clinical judgment are needed to determine the appropriateness of use of a procedure. The purpose of this study is to better understand the reliability and construct validity of this process by comparing ratings of appropriateness for diagnostic upper gastrointestinal endoscopy that were developed using different approaches by two independent groups. Both the RAND/UCLA Health Services Utilization Study (HSUS) and the American Society for Gastrointestinal Endoscopy (ASGE) combined scientific data with expert physician judgment to rate the appropriateness of specific clinical indications for the use of upper gastrointestinal endoscopy. This study applies the ratings developed by each group to a nationally representative sample of 1,585 endoscopies performed on people 65 years of age and older in 1981. HSUS developed indications that could be used to rate all 1,585 procedures; ASGE indications were less comprehensive and applied to 70% (n = 1,115) of procedures. Of those rated by both groups, appropriateness category ratings agreed for 94% of the procedures. However, the procedures not rated by ASGE were unevenly distributed across HSUS appropriateness ratings. Twelve percent of procedures rated as appropriate by HSUS were not rated by ASGE, but 80% of procedures rated as equivocal by HSUS and 73% rated as inappropriate by HSUS were not rated by ASGE, for those procedures rated by both approaches there was good agreement; however, a more explicit and comprehensive method may be required if equivocal and inappropriate use of a procedure is to be identified.

Aged↗
PubMed1978

Value of fiberoptic gastrointestinal endoscopy in infants and children.

Fiberoptic gastrointestinal endoscopy was performed on 52 patients between the ages of 2 months and 16 years. The procedures were safely and easily done with premedications consisting of meperidine, promethazine, and chlorpromazine, and atropine, with diazepam given at the time of the procedure. Fiberoptic endoscopy was particularly helpful in localizing the site of upper gastrointestinal hemorrhage, in retrieving foreign objects, and in removing colonic polyps. In contrast, endoscopy added little to the clinical history and roentgenographic studies in children with recurrent abdominal pain or vomiting, in whom we believe fiberoptic endoscopy is not indicated unless the symptoms or history appear inconsistent with the diagnosis of functional bowel disease.

Abdomen↗
PubMed1996

Development of a sedation policy for upper GI endoscopy based on an audit of patients' perception of the procedure.

OBJECTIVE: To assess patients' perception of upper GI endoscopy, both with and without sedation, and based on this information to propose a sedation policy for the procedure. METHODS: A prospective audit of the experience of patients undergoing upper GI endoscopy both with and without sedation. RESULTS: Of the 500 patients in the study, 237 had endoscopy with sedation and 263 with local anaesthetic throat spray. Sedated patients found the procedure more tolerable, but most unsedated patients felt the extra discomfort was more than compensated for by other advantages. 87% of those patients sedated and 70% of those not sedated would choose to have the procedure repeated in the same way. CONCLUSION: Upper GI endoscopy using local anaesthetic throat spray alone is well tolerated by patients. We have developed a policy on sedation which we believe could result in many more patients electively choosing to have the procedure without sedation, resulting in potential savings on cost and manpower.

Administration, Topical↗
PubMed2003

Differentiation between patients with acute upper gastrointestinal bleeding who need early urgent upper gastrointestinal endoscopy and those who do not. A prospective study.

OBJECTIVE: To differentiate, among patients presented at the emergency department with acute upper gastrointestinal bleeding, those who need early urgent upper gastrointestinal endoscopy from those who do not. METHODS: Seventeen variables for each patient presenting with upper gastrointestinal bleeding were prospectively recorded and considered in a multivariate analysis. We used the presence of active bleeding during early urgent upper gastrointestinal endoscopy within 12 h from admission as the end point. The derived score was validated with data from the next consecutive patients presenting with upper gastrointestinal bleeding. RESULTS: Among 190 consecutive patients (mean age 63.7 +/- 16 years; 64.7% men), active bleeding was observed in 51 patients (26.8%). Four variables were identified as independent predictors (P < 0.05) of active bleeding in early urgent upper gastrointestinal endoscopy and were used for the derivation of the following integer-based scoring system: number of points = 6 (fresh blood in nasogastric tube) + 4 (haemodynamic instability) + 4 (haemoglobin < 8 g/dl) + 3 (white blood cell count > 12 000/microl). The validation study consisted of 110 patients (71 men; mean age 66.1 +/- 14 years; 28 patients [25.5%] with active bleeding). In this study, a cut off of < 7 points indicated absence of active bleeding and >/= 11 points indicated presence of active bleeding; this gave a sensitivity of 96%, specificity of 98%, positive predictive value of 96% and negative predictive value of 98%. CONCLUSIONS: Simple clinical and laboratory variables available at presentation can be used to differentiate patients with upper gastrointestinal bleeding who do not need an early urgent upper gastrointestinal endoscopy from those who do.

Aged↗
PubMed2006

Inter-observer variations on interpretation of capsule endoscopies.

OBJECTIVE: Capsule endoscopy is a novel investigation for diagnosing small bowel diseases. However, its interpretation is highly subjective and the potential variability may compromise its accuracy and reliability. Here we studied the potential inter-observer variations on the interpretation of capsule endoscopy. METHOD: Two residents and one specialist in gastroenterology independently reviewed 58 capsule endoscopy studies in the same sequential order. The gastric transit time, small bowel transit time, and the most significant small bowel lesion were independently recorded. The consensus transit time was determined by the joint review of the three gastroenterologists. The 'gold standard' for small bowel diagnoses was based on final surgical, endoscopic findings or consensus diagnosis. RESULTS: Clinically significant and relevant small bowel lesions were found in 32 (55%) cases by consensus review. The overall mean accuracy in determining gastric emptying time, small bowel transit time and small bowel lesion was 89%, 76% and 80%, respectively. There was a significant difference in the accuracy between the residents and specialist on small bowel transit time (P<0.05) and small bowel diagnosis (P<0.05). The mean kappa values on small bowel diagnosis among the three viewers was 0.56 (range, 0.52-0.59). Among various small bowel diagnoses, small bowel bleeding was more accurately identified than other pathology. CONCLUSIONS: Our results show that there is moderate degree of inter-observer discrepancies on the interpretation of capsule endoscopy. A second reading by an experienced viewer might improve the diagnostic accuracy of this investigation.

Adolescent↗
PubMed2004

Diaphragm disease after use of nonsteroidal anti-inflammatory agents: first report of diagnosis with capsule endoscopy.

Diaphragm disease of the small intestine is part of the spectrum of diseases associated with injury to the gastrointestinal tract induced by nonsteroidal anti-inflammatory drugs. Standard endoscopy or contrast studies of the small intestine rarely identify these lesions. The diagnosis usually is established at the time of surgery. We report the case of a 72-year-old woman with obscure gastrointestinal bleeding and intermittent obstruction of the small intestine who had had multiple hospitalizations and extensive testing. The patient had been treated with nonsteroidal anti-inflammatory drugs for osteoarthritis. A radiograph of the small intestine with barium contrast revealed no abnormalities, so capsule endoscopy was performed. Capsule endoscopy showed multiple small intestinal strictures beyond which the capsule could not pass. After the patient experienced continued symptoms suggestive of intermittent partial obstruction of the small intestine, computed tomography showed the capsule within a dilated loop of intestine adjacent to a stricture. After 9 days of conservative medical therapy and worsening symptoms, the patient required an exploratory laparotomy. The capsule was located in a 12-cm segment of intestine with 4 diaphragm-like lesions. Pathologic study found submucosal lesions with features identical to those of neuromuscular and vascular hamartoma (eg, mature, reactive tissue elements of smooth muscle, dense fibrous tissue, and nerve tissue bundles with scattered ganglion cells and vessels). No manifestations of Crohn disease were evident. This case represents the first diagnosis with capsule endoscopy of diaphragm disease of the small intestine with pathologic features of neuromuscular and vascular hamartoma.

Aged↗
PubMed2004

Neurologic diagnosis and treatment in patients with computed tomography and nasal endoscopy negative facial pain.

OBJECTIVE: To determine the helpfulness of specialist neurology referral for patients with facial pain, a normal sinus computed tomography (CT) scan, and normal nasal endoscopy findings. STUDY DESIGN: Prospective identification of patients and analysis of data approved by the Institutional Review Board. METHODS: The data of 104 consecutive patients presenting with facial pain, a normal sinus CT scan, and normal nasal endoscopy findings were reviewed. The patients presented to a single rhinologist in a tertiary care institution. All patients were referred for specialist neurologic evaluation and potential treatment. Further information was obtained from a patient survey. RESULTS: Of the 104 patients, 81 were women and 23 were men. The average age was 46 years (range, 22-85). Fifty-six had clear CT scans, 48 had minimal change, and all had negative endoscopies. Twenty-nine had previous unsuccessful sinus surgery. The average follow-up period was 10.5 months. Forty of 75 patients seeing a neurologist were seen on multiple occasions. Four percent of patients seen by a neurologist had an unsuspected serious intracranial diagnosis. The most common diagnoses were migraine (37%), rebound headache (17%), chronic daily headache (17%), and obstructive sleep apnea (16%). Overall, 58% improved on medical therapy; 60% of those with a clear CT scan improved, and 53% of those with minimal change on CT scan improved (P = .749). CONCLUSIONS: Facial pain remains a difficult symptom to diagnose and treat in rhinologic practice. Patients often undergo surgery without help. Most patients with facial pain, a normal sinus CT scan, and normal endoscopy findings benefit from neurologic consultation. Serious intracranial pathologic conditions can be excluded and diagnosis-specific pharmacogenetic therapy instituted with improvement in more than 50%.

Adult↗
PubMed2005

Endoscopy in celiac disease.

PURPOSE OF REVIEW: The primary objective of this review is to highlight the evidence for the role of endoscopy in celiac disease. RECENT FINDINGS: Evidence is presented that the endoscopic markers of celiac disease are specific although not sensitive for the disease. Villous atrophy, the hallmark of celiac disease, is patchy in the duodenum, and various techniques may identify areas of villous atrophy. These methods include magnification endoscopy and chromoendoscopy. The most recent innovation, video capsule endoscopy, may be of value in the diagnosis of celiac disease and in the assessment of patients with complicated celiac disease. SUMMARY: Endoscopy and duodenal biopsies are the mainstay for diagnosing celiac disease. Although characteristic endoscopic features may be useful, their absence does not exclude celiac disease. Random biopsy, even of normal-appearing mucosa is necessary for the diagnosis of celiac disease.

Celiac Disease↗
PubMed2006

Nasal and paranasal sinus carcinoma: how can we continue to make progress?

PURPOSE OF REVIEW: New developments in the nasal and paranasal sinus cancers are reviewed. RECENT FINDINGS: In addition to woodworking, several risk factors for nasal and paranasal sinus cancers have been identified, most notably smoking. Progress in the differential diagnosis of small round cell nasal and paranasal sinus cancers allows the precise diagnosis of esthesioneuroblastoma. Despite recent improvements, T staging for ethmoid and nasal cavity needs refinement. An association of surgery and radiation therapy remains the best treatment modality. Major developments include endoscopic resection of nasal and paranasal sinus cancers, high-precision radiotherapy techniques such as intensity-modulated radiotherapy, and proton-beam radiotherapy. There is probably no role for chemotherapy in esthesioneuroblastoma. Although chemotherapy is important for aggressive neoplasms, its generalized use for nasal and paranasal sinus cancers awaits the application/development of newer drugs. These drugs might be applied locally since the majority of recurrences remain local. SUMMARY: Progress in the treatment of nasal and paranasal sinus cancers could be achieved through better prevention and the developments of more selective treatments such as endoscopic resection, high-precision radiotherapy, and new chemotherapy drugs.

Carcinoma↗
PubMed2006

Age threshold for endoscopy and risk of missing upper gastrointestinal malignancy--data from the Scottish audit of gastric and oesophageal cancer.

BACKGROUND: Urgent endoscopy is indicated for suspected upper gastrointestinal malignancy. However, there is limited evidence on the age threshold for performing urgent endoscopy in uncomplicated dyspepsia (that is, without alarm features). AIM: To quantify the risk of missing upper gastrointestinal malignancy within Scotland, if the age threshold for urgent endoscopy in uncomplicated dyspepsia was increased from 45 to 55 years. METHODS: Analysis of data collected prospectively by the Scottish Audit of Gastric and Oesophageal Cancer. 'Alarm' features at presentation were defined as dysphagia, weight loss, gastrointestinal bleeding, anaemia, vomiting, history of gastric surgery and history of peptic ulcer disease. RESULTS: Of the 3293 patients diagnosed with upper gastrointestinal malignancy, 290 (8.8%) patients were <55 years of age. Twenty-one of the patients aged <55 years had no alarm features (0.64% of all patients); 12 were aged 45-55 years and nine were aged <45 years. Only two patients (one aged <45 years) underwent potentially curative surgery. CONCLUSION: Upper gastrointestinal malignancy is uncommon under 55 years of age and most of the patients present with alarm features. Raising the age threshold for endoscopy for new-onset uncomplicated dyspepsia from 45 to 55 years would not impact adversely on the diagnosis or outcome of upper gastrointestinal malignancy.

Adult↗
PubMed2006

Acetic acid-enhanced magnification endoscopy in the diagnosis of specialized intestinal metaplasia, dysplasia and early cancer in Barrett's oesophagus.

BACKGROUND: Barrett's surveillance is prone to sampling error. Aim To determine whether enhanced magnification endoscopy using acetic acid instillation improves diagnostic accuracy of specialized intestinal metaplasia/dysplasia in Barrett's oesophagus. METHODS: We examined the detection rate of the specialized intestinal metaplasia/dysplasia in 64 consecutive patients with Barrett's oesophagus using acetic acid to enhance mucosal pit patterns. Histology was compared with the previous findings at recent conventional surveillance in 62 patients. We also examined the inter-/intra-observer agreement in the assessment of the enhanced magnification endoscopy pit pattern findings. RESULTS: Histology revealed columnar-lined oesophagus in six (9%) patients, specialized intestinal metaplasia in 49 (77%), low-grade dysplasia in five (8%), high-grade dysplasia in one (2%), and adenocarcinoma in three (5%). There was discordance between the histologic findings from conventional surveillance with random biopsy. Fifteen patients (24%) had a histological upgrade with enhanced magnification endoscopy. There was a high detection rate of specialized intestinal metaplasia even in short segment Barrett's oesophagus (74%), and additionally, there were two cancers, one with 2-cm Barrett's oesophagus and one ultra-short (1 cm). The mean kappa values for inter- and intra-observer agreement in assessing the pit patterns were 0.571 (0.041) and 0.709 (0.038), respectively. CONCLUSIONS: Enhanced magnification endoscopy allows clear visualization of the epithelial pit patterns within Barrett's oesophagus, and targeted biopsy results in a high yield of specialized intestinal metaplasia and dysplasia.

Acetic Acid↗
PubMed2006

Review article: moderate sedation for endoscopy: sedation regimens for non-anaesthesiologists.

BACKGROUND: Moderate sedation is a drug-induced depression of consciousness during which patients respond purposefully to verbal commands with or without light tactile stimulation. Moderate sedation is typically accepted in the anaesthesia community as an appropriate target for sedation by non-anaesthesiologists. AIM: To describe drug regimens that can be successfully and safely targeted to moderate sedation for endoscopy by non-anaesthesiologists. RESULTS: Moderate sedation can be achieved using narcotics and benzodiazepines. There is interest in some countries in propofol for endoscopy, which is often viewed as an agent for deep sedation. Indeed, propofol cannot be targeted to moderate sedation for endoscopy as a single agent because of coughing during upper endoscopy and pain withdrawal responses during colonoscopy. Pre-treatment with low doses of narcotic and/or benzodiazepine blocks these effects, allowing propofol to be targeted to moderate sedation. Fospropofol, a prodrug of propofol in clinical development, can also be targeted to moderate sedation if co-administered with narcotic. CONCLUSION: Moderate sedation provides a safety margin when compared with deep sedation and general anaesthesia. Development of protocols that target agents such as propofol to moderate sedation will expand the sedation agents available to non-anaesthesiologists and help ensure that this expansion occurs safely.

Anesthesia↗