Endoscopic Sedation Practices Research Articles

A survey among Flemish gastroenterologists about endoscopic sedation practices in colorectal cancer screening.

The sedation levels and methods used for colonoscopy in colorectal cancer screening programs vary from country to country and from continent to continent. Little is known in the literature about how frequently the different sedation levels are used in colorectal cancer screening colonoscopies. We made a survey among all Flemish gastroenterologists (GI) to determine how frequently they use the different sedation modalities in this target population and to determine the motives of the GI to opt for one or another sedation modality. An online survey was sent to all 329 Flemish GI by e-mail. A reminder e-mail was sent one month later. Participants could indicate how frequently (by percentage) they used the different sedation methods (no sedation, minimal sedation, conscious sedation, deep sedation) and which sedative medication they administered. In addition, they were asked to indicate their main motives for choosing a specific sedation method. Descriptive statistics were used. 112 out of 329 GI answered the questionnaire (response rate 34%). Anesthesia monitored care is the most frequently used sedation modality, followed by conscious sedation. Patient preference is the main motive for most GI to use each sedation modality. Anesthesia monitored care is currently the most frequently used sedation regimen to perform a colonoscopy in the FIT positive population or in the colorectal cancer screening program in Flanders. The motives given by the GI for choosing one or another sedation modality are not always congruent with current scientific evidence or guidelines.

Endoscopic sedation practices of Greek gastroenterologists: a nationwide survey.

Background:Sedation in gastrointestinal endoscopy is rapidly evolving worldwide. However, this has led to significant disagreements, especially regarding the use of propofol by non-anesthesiologists. The aim of this study was to document the practices of Greek gastroenterologists regarding sedation and compare them to previous surveys.Methods:The study was conducted in 2 periods, December 2015 and June 2018. In each period, the same online questionnaire regarding endoscopic sedation practices was sent to all registered Greek gastroenterologists (509 and 547 gastroenterologists, respectively).Results:The response rates were 38.3% and 47.1%, respectively. In each period, 25.1% and 16.7% of physicians did not use sedation. Most gastroenterologists (approx. 70% in both instances) answered that they “almost never” collaborate with an anesthesiologist during endoscopy. Midazolam was by far the most popular sedation agent, used by almost 90% of physicians in both periods. Propofol was used by 30.8% and 27% of physicians, respectively. Physicians using propofol were significantly more satisfied with the sedation than other physicians, while propofol was the agent selected by most physicians if they were to undergo endoscopy themselves. Most physicians cited medicolegal reasons and inadequate training as chief reasons for not using propofol.Conclusions:Sedation use is widespread among Greek gastroenterologists. Although midazolam is the most commonly used agent, propofol is preferred (theoretically) by most physicians and achieves the best satisfaction. The introduction of a strict training curriculum for endoscopic sedation can effectively eliminate the barriers preventing gastroenterologists from administering propofol, while at the same time ensuring optimal patient safety during endoscopy.

Pediatric Gastrointestinal Endoscopic Sedation: A 2010 Nationwide Survey in Taiwan

There is insufficient data on pediatric endoscopic sedation practices worldwide. This study aimed to assess nationwide data on the current pediatric endoscopic sedation practices in Taiwan. Members of the Taiwan Society of Pediatric Gastroenterology Hepatology and Nutrition in 2010 were asked to participate in an 18-item questionnaire survey regarding current sedation practices for diagnostic esophagogastric-duodenoscopy (EGD). A total of 22 of 32 questionnaires were returned for a response rate of 68.8%. A majority (86.4%) of the respondents practiced in a medical center hospital setting, and 72.7% preferred sedation during EGD. The proportions of respondents applying sedative methods in cases aged < 1, 1∼12, and > 12 years old were 85.7%, 100%, and 23.7% respectively. Ketamine (27.8%) and midazolam with meperidine (22.2%) were the most commonly applied sedation agents, while the percentage of respondents using regimens that included propofol was 11.2%. Comparing complications between EGD with and without sedation, only hypoxia (Wilcoxon statistics=347.00, p=0.003) was significantly more common in sedated patients. The endoscopists' satisfaction rating was greater among respondents using sedation compared to those without (visual analog scale 9 vs. 7; p=0.0001). A majority of pediatric EGD in Taiwan was performed under sedation and applied more often to younger children. Endoscopists were more satisfied during EGD when practicing sedation. This survey should help formulate updated practice guidelines and policies regarding endoscopic sedation.

Randomised clinical trial: a ‘nudge’ strategy to modify endoscopic sedation practice

In behavioural economics, a 'nudge' describes configuration of a choice to encourage a certain action without taking away freedom of choice. To determine the impact of a 'nudge' strategy - prefilling either 3mL or 5mL syringes with midazolam - on endoscopic sedation practice. Consecutive patients undergoing sedation for EGD or colonoscopy were enrolled. On alternate weeks, midazolam was prefilled in either 3mL or 5mL syringes. Preprocedure sedation was administered by the endoscopist to achieve moderate conscious sedation; dosages were at the discretion of the endoscopist. Meperidine was not prefilled. Overall, 120 patients received sedation for EGD [59 (5mL), 61 (3mL)] and 86 patients were sedated for colonoscopy [38 (5mL), 48 (3mL)]. For EGDs, average midazolam dose was significantly higher in the 5-mL group (5.2mg) vs. 3-mL group (3.3mg), (P<0.0001); for colonoscopies, average midazolam dose was also significantly higher in the 5-mL group (5.1mg) vs. 3-mL group (3.3mg), (P<0.0001). There was no significant difference in mean meperidine dose (42.1mg vs. 42.8mg, P=0.9) administered to both colonoscopy groups. No adverse sedation-related events occurred; no patient required reversal of sedation. These findings demonstrate that 'nudge' strategies may hold promise in modifying endoscopic sedation practice. Further research is required to explore the utility of 'nudges' in impacting other aspects of endoscopic practice.

472 Randomized Controlled Trial of a ‘Nudge’ Strategy to Modify Endoscopic Sedation Practice

In behavioural economics, a ‘nudge’ is a term to describe configuration of a choice to encourage a certain course of action without taking away freedom of choice. In politics and economics, 'nudges' are being used increasingly to encourage people to make certain choices without forcing outcomes on them. This study aimed to determine the impact of a ‘nudge’ strategy - pre-filling either 3 mL or 5 mL syringes with midazolam - on endoscopic sedation practice.

Endoscopic Sedation in Developing and Developed Countries

Data are scarce on endoscopic sedation practices outside the United States and Western Europe, particularly from developing nations. An Internet survey was used to assess endoscopic sedation practices in developing and developed countries. Responses to a Web-based survey of sedation practices from 165 expert endoscopists from 81 countries were analyzed. The most common sedation method was defined as that used for >50% of endoscopies within a country. Responses were received from 84 endoscopists practicing in 46 countries (51% response rate; 32 responses from 22 developing countries and 52 responses from 24 developed countries). A combination of benzodiazepine and opioid was the most common method for esophagogastroduodenoscopy (EGD) in 40% of the countries and for colonoscopy in 56% of the countries. For propofol and unsedated endoscopy, the corresponding figures were 8% and 19% for EGD and 18% and 10% for colonoscopy. No single sedation method accounted for >50% of EGD and colonoscopy cases in 32% and 17% of the countries, respectively. There were no significant differences in the proportions of developing and developed countries using combined benzodiazepine and opioid, propofol, or unsedated endoscopy. Sedation is used for most endoscopic procedures worldwide, with sedation practice not differing significantly between developing and developed countries.

Results of a National Survey of Endoscopic Sedation Practice for Patients with Obstructive Sleep Apnea

Purpose: Conscious sedation used during endoscopic procedures is thought to be associated with an increased risk for cardiopulmonary complications in patients with obstructive sleep apnea. We performed a national survey of gastrointestinal endoscopists to determine sedation practices in OSA patients. Methods: A two page survey was initially mailed to members of the regional endoscopy society. The survey was then revised to eliminate ambiguous questions and mailed to a random subset of ASGE members. Most questions were multiple choice and included items on physician demographics, training, and reported practice for sedation during endoscopic procedures in patients with diagnosed or suspected OSA. Results: A total of 187 (39%) of 580 mailed surveys were returned. Most endoscopists (66.8%) reported no difference in their anesthetic approach for EGD versus colonoscopies in OSA patients. Thirty-six percent felt that lighter conscious sedation was adequate for all OSA patients, whereas 18% of endoscopists used anesthesia services for all procedures. Sedation practices for patients known to use CPAP or home oxygen varied with the largest proportion of endoscopists reporting lighter sedation as the only special precaution (28% and 25% respectively). Twenty-three and 33.8% percent felt that either a hospital endoscopy unit or anesthesia assistance was required for OSA patients and patients on home oxygen, respectively. Forty-six percent of respondents referred patients for OSA evaluation if they had apneic episodes during endoscopy. Conclusion: There is a wide variation in conscious sedation practices for OSA patients among gastrointestinal endoscopists. Lighter sedation rather than anesthesiologist administered sedation appears to be the preferred management approach for gastrointestinal endoscopy in these patients.