Sedation-related complications in gastrointestinal endoscopy

Abstract

Sedation practices for gastrointestinal endoscopic (GIE) procedures vary widely in different countries depending on health system regulations and local circumstances. The goal of procedural sedation is the safe and effective control of pain and anxiety, as well as to provide an appropriate degree of memory loss or decreased awareness. Sedation-related complications in gastrointestinal endoscopy, once occurred, can lead to significant morbidity and occasional mortality in patients. The risk factors of these complications include the type, dose and mode of administration of sedative agents, as well as the patient’s age and underlying medical diseases. Complications attributed to moderate and deep sedation levels are more often associated with cardiovascular and respiratory systems. However, sedation-related complications during GIE procedures are commonly transient and of a mild degree. The risk for these complications while providing any level of sedation is greatest when caring for patients already medically compromised. Significant unwanted complications can generally be prevented by careful pre-procedure assessment and preparation, appropriate monitoring and support, as well as post-procedure management. Additionally, physicians must be prepared to manage these complications. This article will review sedation-related complications during moderate and deep sedation for GIE procedures and also address their appropriate management.

Keywords: Sedation; Complication; Gastrointestinal; Endoscopy

Core tip: Gastrointestinal endoscopic (GIE) procedures are relatively safe. However, these procedures have been shown to cause various effects on cardiorespiratory systems. Sedation-related complications while providing any level of sedation can occur. Fortunately, these complications during GIE procedures are commonly transient and of a mild degree. In addition, significant unwanted complications can generally be prevented by careful pre-procedure assessment and preparation, appropriate monitoring and support. Periodical assessment of the level of sedation and continuous monitoring of cardiovascular and respiratory systems provides timely information. Standardized discharge criteria should be used to determine the patient’s readiness for discharge.