Sedation and Analgesic Considerations for Gastrointestinal Procedures

Gastrointestinal (GI) procedures are performed in various settings and are important for prevention and treatment of various disease states. For many years, these procedures were commonly performed with a combination of opioids and benzodiazepines. However, in recent years, there has been a significant shift to propofol, allowing for both moderate and deep sedation. Propofol has been popular with patients and has sedative effects with no known antidote. Baseline vital signs, physical examination, and past medical history are always required for any patient who is to receive anesthesia. Further, sedation involving propofol requires airway expertise, since its delivery can result in hypoxia and respiratory depression. Of note, standard monitoring nationwide requires temperature, blood pressure, electrocardiogram, pulse oximetry, and quantitative continuous end tidal CO2 monitoring. Given that many GI procedures are performed in the lateral and prone positions, it is essential for safety to utilize all five standards monitors to provide safe anesthesia for these patients. While midazolam and fentanyl remain popular for many patients needing moderate sedation, a deeper level of sedation is most typically achieved with propofol related to increased patient satisfaction and ideal pharmacokinetics. New anesthetic agents such as the alpha-2 agonist dexmedetomidine are being evaluated to aid GI sedation. To reduce potential adverse events during GI procedural anesthesia, anesthesiology services are recommended for most patients and particularly in high-risk populations requiring deep sedation. In summary, the strongest emphasis should be placed on utilization of ASA standard monitors for all patients undergoing GI procedures. Continuous quantitative end tidal CO2 monitoring must be employed for safe delivery of sedation for any GI procedure.