Published online Feb 16, 2015. doi: 10.4253/wjge.v7.i2.102
Peer-review started: July 18, 2014
First decision: August 28, 2014
Revised: September 10, 2014
Accepted: November 7, 2014
Article in press: November 10, 2014
Published online: February 16, 2015
Gastrointestinal endoscopies are invasive and unpleasant procedures that are increasingly being used worldwide. The importance of high quality procedures (especially in colorectal cancer screening), the increasing patient awareness and the expectation of painless examination, increase the need for procedural sedation. The best single sedation agent for endoscopy is propofol which, due to its’ pharmacokinetic/dynamic profile allows for a higher patient satisfaction and procedural quality and lower induction and recovery times, while maintaining the safety of traditional sedation. Propofol is an anesthetic agent when used in higher doses than those needed for endoscopy. Because of this important feature it may lead to cardiovascular and respiratory depression and, ultimately, to cardiac arrest and death. Fueled by this argument, concern over the safety of its administration by personnel without general anesthesia training has arisen. Propofol usage seems to be increasing but it’s still underused. It is a safe alternative for simple endoscopic procedures in low risk patients even if administered by non-anesthesiologists. Evidence on propofol safety in complex procedures and high risk patients is less robust and in these cases, the presence of an anesthetist should be considered. We review the existing evidence on the topic and evaluate the regional differences on sedation practices.
Core tip: Sedation in endoscopy is a hot topic. There is a wide range of practices depending on the countries and even regionally at a national level. These differences range from no sedation to traditional sedation or propofol based sedation (with or without an anesthetist) and are the result of several factors which include cultural aspects, medical training, legal responsibility and societal lobbying. Herein we review the most important evidence regarding the sedation aspects in the endoscopy suite and compare practices which vary among several countries.