Sedation in gastrointestinal endoscopy: Where are we at in 2014?

Table 1 Pharmacologic profile of commonly used drugs for procedural sedation

Drugs	Onset of action (min)	Duration of action (min)	Usual doses	FDA pregnancy category	Adverse effects
Pethidine	3-6	60-180	25-100 mg	C	Respiratory depression, vomiting
Fentanyl	1-2	30-60	50-200 μg	C	Respiratory depression, vomiting
Alfentanyl	< 1	30-60	0.250-2 mg	C	Respiratory and cardiovascular depression
Midazolam	1-2	15-80	1-6 mg	D	Respiratory depression, disinhibition
Propofol	< 1	4-8	40-400 mg	B	Respiratory and cardiovascular depression
Flumazenil	1-2	60	0.1-1 mg	C	Agitation, withdrawal symptoms
Naloxone	1-2	30-45	0.2-1 mg	B	Narcotic withdrawal

Table 2 Meta-analysis of randomized controlled trials of propofol vs traditional sedation in endoscopy

Ref.	Procedures	Sedation compared	No. of studies (cases)	OR (95%CI) for adverse events
Qadeer et al[23], 2005	EGD/colonoscopy/ERCP/EUS	Propofol vs traditional sedation	12 (1161)	0.74 (0.44-1.24)
Singh et al[2], 2008	Colonoscopy	Propofol vs traditional sedation	22	Hypoxia: 0.69 (0.25-1.89); Hypotension: 1.03 (0.28-3.83)
Bo et al[21], 2011	ERCP	Propofol vs traditional sedation	6 (663)	1.69 (0.82-3.50)
Garewal et al[24], 2012	ERCP	Propofol vs traditional sedation	4 (510)	Narrative
Wang et al[1], 2013	EGD/colonoscopy/ERCP	Propofol vs traditional sedation	22 (1798)	0.90 (0.70-1.17)

EGD: Esophagogastroduodenoscopy.

Table 3 Existing societal guidelines for non-anesthesiologist administration of propofol

Scientific society	Limitations	Consider anethesiologist
Sociedad Española de Endoscopia Digestiva, 2014	Complex procedure; ASA III	ASA ≥ III; long/complex procedure; difficult airway
Austrian Society of Gastroenterology and Hepatology (OGGH), 2007	NA	NA
Canadian Association of Gastroenterology, 2008	NA	ASA ≥ III; long/complex procedure; difficult airway
German S3 guidelines - DGVS/DGAI, 2008	ASA ≥ III; long/complex procedure; difficult airway	ASA ≥ IV; long/complex procedure; difficult airway
European Society of Gastrointestinal Endoscopy (ESGE/ESGENA), 2010/2013	NA	ASA ≥ III; long/complex procedure; difficult airway
American multisociety guideline - AGA/ACG/ASGE/AASLD, 2009/2012	NA	ASA ≥ III; long/complex procedure; difficult airway

ASGE: American Society of Gastrointestinal Endoscopy; NA: Not available.