Published online Jul 28, 2013. doi: 10.3748/wjg.v19.i28.4633
Revised: June 10, 2013
Accepted: June 18, 2013
Published online: July 28, 2013
Sedation practices vary according to countries with different health system regulations, the procedures done, and local circumstances. Interestingly, differences in the setting in which the practice of gastroenterology and endoscopy takes place (university-based vs academic practice) as well as other systematic practice differences influence the attitude of endoscopists concerning sedation practices. Conscious sedation using midazolam and opioids is the current standard method of sedation in diagnostic and therapeutic endoscopy. Interestingly, propofol is a commonly preferred sedation method by endoscopists due to higher satisfaction rates along with its short half-life and thus lower risk of hepatic encephalopathy. On the other hand, midazolam is the benzodiazepine of choice because of its shorter duration of action and better pharmacokinetic profile compared with diazepam. The administration of sedation under the supervision of a properly trained endoscopist could become the standard practice and the urgent development of an updated international consensus regarding the use of sedative agents like propofol is needed.
Core tip: Even though the most recent “Multisociety sedation curriculum for gastrointestinal endoscopy” guidelines addressed the upper-limit range of Midazolam for proper sedation in prolonged endoscopic procedures, there are no clear-cut guidelines on the upper limit of Fentanyl dosing, especially with the risk of rigid chest syndrome and drug accumulation in skeletal muscle at high doses. Additionally, we also raised the question of whether Propofol or other agents used for deep sedation should be a routine indication for patients with chronic opioid use.