Opinion Review
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Meta-Anal. Mar 28, 2020; 8(2): 48-53
Published online Mar 28, 2020. doi: 10.13105/wjma.v8.i2.48
Effectiveness and safety of sedation in gastrointestinal endoscopy: An opinion review
Ryoji Ichijima, Mitsuru Esaki, Sho Suzuki, Chika Kusano, Hisatomo Ikehara, Takuji Gotoda
Ryoji Ichijima, Mitsuru Esaki, Sho Suzuki, Chika Kusano, Hisatomo Ikehara, Takuji Gotoda, Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Chiyoda-ku, Tokyo 101-8309, Japan
Author contributions: Ichijima R and Esaki M drafted the manuscript; Suzuki S, Kusano C, Ikehara H and Gotoda T critically revised the manuscript; all authors approved the final version of the manuscript.
Conflict-of-interest statement: All authors declared to have no disclosures relevant to this manuscript.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Mitsuru Esaki, MD, Doctor, Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, 1-6 Kanda-Surugadai, Chiyoda-ku, Tokyo 101-8309, Japan. esaki_saiseikai@yahoo.co.jp
Received: December 26, 2019
Peer-review started: December 26, 2019
First decision: February 24, 2020
Revised: March 4, 2020
Accepted: March 19, 2020
Article in press: March 19, 2020
Published online: March 28, 2020
Processing time: 124 Days and 10.7 Hours
Abstract

Although endoscopy is a less invasive procedure than surgery, patients can experience pain without sedation. Patients expect reduced pain during endoscopies from effective and safe sedatives. Midazolam and propofol are used for endoscopic sedation in many countries and regions. Midazolam is a widely available benzodiazepine, and many clinical trials have shown it to be an effective sedative. However, patients who are sedated with midazolam require rest in the recovery room due to its relatively long half-life, and an antagonist such as flumazenil may need to be administered in cases of deep or prolonged sedation. Propofol is a short-acting sedative with a short half-life and a quick recovery time. Therefore, the use of propofol has been increasing. However, propofol has a narrow margin of safety and often induces adverse effects such as respiratory depression. Also, propofol has no specific antagonist, and should be administered by an anesthesiologist or an endoscopist familiar with anesthesia. Remimazolam, which is a novel ultra-short-acting benzodiazepine, has recently gained attention. Remimazolam has a short half-life and an antagonist. Both effective and safe sedation is desired in accordance with the increasing need for sedative endoscopies. Therefore, in this review each sedative is summarized.

Keywords: Gastrointestinal endoscopy; Conscious sedation; Propofol; Midazolam; Remimazolam; Benzodiazepine

Core tip: The need for sedation during gastrointestinal endoscopies is ever increasing. Currently, benzodiazepines such as midazolam and the short acting propofol are the most commonly used sedatives for an endoscope. However, midazolam requires the patient to have an extended recovery period and in cases of a deep sedation an antagonist administered. Although short acting, propofol must be administered by an anesthesiologist due to its potential side effects and does not have an antagonist. Remimazolam is ultra-short acting and has both a short half-life and if required an antagonist. In this review we discuss the advantages and disadvantages of each sedative.