The changing faces of endoscopic sedation

Abstract

The practice of sedation for digestive endoscopy continues to evolve throughout the world. In many countries, there is a trend for increased utilization of sedation during routine endoscopic procedures. Sedation improves patient satisfaction with endoscopy and the willingness to comply with screening guidelines and it improves the quality of examination. Moderate sedation, using a benzodiazepine and an opioid, remains the standard method of sedation in most areas of the world, although propofol, a short-acting hypnotic agent, is being used increasingly in some countries. Controversy regarding the feasibility of endoscopist-directed propofol administration continues, in spite of overwhelming evidence supporting this practice. In the USA, recent revisions in policy by the Centers for Medicare and Medicaid Services may threaten the practice of endoscopist-directed propofol administration. In this article, future trends in sedation practice, including fospropofol and computer-assisted personalized sedation, are discussed.

Keywords::

• anesthesia
• colonoscopy
• conscious sedation
• endoscopy
• healthcare delivery
• health economics
• propofol

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.