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World J Gastrointest Endosc. Jan 16, 2013; 5(1): 1-5
Published online Jan 16, 2013. doi: 10.4253/wjge.v5.i1.1
Use of anesthesia on the rise in gastrointestinal endoscopy
Basil Al-Awabdy, C Mel Wilcox
Basil Al-Awabdy, C Mel Wilcox, Division of Gastroenterology and Hepatology, University of Alabama at Birmingham, Birmingham, AL 35294, United States
Author contributions: Al-Awabdy B and Wilcox CM wrote the manuscript.
Correspondence to: C Mel Wilcox, MD, MSPH, Division of Gastroenterology and Hepatology, University of Alabama at Birmingham, BDB 380, 1720 2nd Avenue, South, Birmingham, AL 35294, United States. melw@uab.edu
Telephone: +1-205-9754958 Fax: +1-205-9348493
Received: August 2, 2012
Revised: September 25, 2012
Accepted: December 1, 2012
Published online: January 16, 2013
Abstract

Conscious sedation has been the standard of care for many years for gastrointestinal endoscopic procedures. As procedures have become more complex and lengthy, additional medications became essential for adequate sedation. Often time’s deep sedation is required for procedures such as endoscopic retrograde cholangiography which necessitates higher doses of narcotics and benzodiazepines or even use of other medications such as ketamine. Given its pharmacologic properties, propofol was rapidly adopted worldwide to gastrointestinal endoscopy for complex procedures and more recently to routine upper and lower endoscopy. Many studies have shown superiority for both the physician and patient compared to standard sedation. Nevertheless, its use remains highly controversial. A number of studies worldwide show that propofol can be given safely by endoscopists or nurses when well trained. Despite this wealth of data, at many centers its use has been prohibited unless administered by anesthesiology. In this commentary, we review the use of anesthesia support for endoscopy in the United States based on recent data and its implications for gastroenterologists worldwide.

Keywords: Propofol; Ketamine; Conscious sedation; Deep sedation; Anesthesiology; Gastrointestinal endoscopy