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BSG Guidelines on Safety and Sedation during Endoscopy Procedures 2018
Conscious sedation is defined as: "a technique in which the use of drug(s) produces a state of depression of the central nervous system enabling treatment to be carried out, but during which verbal contact with the patient is maintained throughout the period of sedation. The drug and techniques used to provide conscious sedation should carry a margin of safety wide enough to render loss of consciousness unlikely".
If verbal responsiveness is lost the patient requires a level of care identical to that needed for general anaesthesia.
- Most endoscopic practices recommend that Midazolam 5mg should be the maximum dose given and that elderly patients are given 1-2 mg initially with a sensible pause to observe effect.
- All sedated patients must have a flexible intravenous cannula in situ throughout the procedure and recovery period.
- Oxygen should be given to all sedated patients.
- Pulse oximetry monitoring should be used in all sedated patients and ECG and blood pressure monitoring should be readily available for high risk patients.
Sedatives and anxiolytics e.g. benzodiazepines have no analgesic properties in conventional doses. Pain control e.g. fentanyl and pethidine should be wherever possible given before benzodiazepine.
- Doses in excess of Pethidine 50mg or Fentanyl 100mcg are seldom required and elderly patients will require dose reduction (usually below 50%) when these drugs are used.
- Entonox is a 50/50 mixture of nitrous oxide and oxygen with good analgesic but little hypnotic effect. "Washout time" of 5-10 minutes. It is not safe for use in patients who have compromised respiratory function or pneumothorax.
- Drugs such as Propofol, Ketamine and analogous compounds require specialist knowledge, skills and equipment and should never be used without the presence of a trained anaesthetist.
References
British Society of Gastroenterology. BSG Guidelines on Safety and Sedation during Endoscopy Procedures 2018. Retrieved from:www.bsg.org.uk/resource/guidelines-on-safety-and-sedation-for-endoscopic-procedures.html
Author:
Ms Yanyu Tan
| Speciality:
General Surgery
| Date Added:
12/11/2019
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