Copyright ©The Author(s) 2015.
World J Gastrointest Endosc. Feb 16, 2015; 7(2): 102-109
Published online Feb 16, 2015. doi: 10.4253/wjge.v7.i2.102
Table 1 Pharmacologic profile of commonly used drugs for procedural sedation
DrugsOnset of action (min)Duration of action (min)Usual dosesFDA pregnancy categoryAdverse effects
Pethidine3-660-18025-100 mgCRespiratory depression, vomiting
Fentanyl1-230-6050-200 μgCRespiratory depression, vomiting
Alfentanyl< 130-600.250-2 mgCRespiratory and cardiovascular depression
Midazolam1-215-801-6 mgDRespiratory depression, disinhibition
Propofol< 14-840-400 mgBRespiratory and cardiovascular depression
Flumazenil1-2600.1-1 mgCAgitation, withdrawal symptoms
Naloxone1-230-450.2-1 mgBNarcotic withdrawal
Table 2 Meta-analysis of randomized controlled trials of propofol vs traditional sedation in endoscopy
Ref.ProceduresSedation comparedNo. of studies (cases)OR (95%CI) for adverse events
Qadeer et al[23], 2005EGD/colonoscopy/ERCP/EUSPropofol vs traditional sedation12 (1161)0.74 (0.44-1.24)
Singh et al[2], 2008ColonoscopyPropofol vs traditional sedation22Hypoxia: 0.69 (0.25-1.89); Hypotension: 1.03 (0.28-3.83)
Bo et al[21], 2011ERCPPropofol vs traditional sedation6 (663)1.69 (0.82-3.50)
Garewal et al[24], 2012ERCPPropofol vs traditional sedation4 (510)Narrative
Wang et al[1], 2013EGD/colonoscopy/ERCPPropofol vs traditional sedation22 (1798)0.90 (0.70-1.17)
Table 3 Existing societal guidelines for non-anesthesiologist administration of propofol
Scientific societyLimitationsConsider anethesiologist
Sociedad Española de Endoscopia Digestiva, 2014Complex procedure; ASA IIIASA ≥ III; long/complex procedure; difficult airway
Austrian Society of Gastroenterology and Hepatology (OGGH), 2007NANA
Canadian Association of Gastroenterology, 2008NAASA ≥ III; long/complex procedure; difficult airway
German S3 guidelines - DGVS/DGAI, 2008ASA ≥ III; long/complex procedure; difficult airwayASA ≥ IV; long/complex procedure; difficult airway
European Society of Gastrointestinal Endoscopy (ESGE/ESGENA), 2010/2013NAASA ≥ III; long/complex procedure; difficult airway
American multisociety guideline - AGA/ACG/ASGE/AASLD, 2009/2012NAASA ≥ III; long/complex procedure; difficult airway