Sedation for gastrointestinal endoscopy: European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastroenterology and Endoscopy Nurses and Associates (ESGENA) Guideline.

内容摘要

ESGE and ESGENA recommend that informed consent for gastrointestinal endoscopic procedures should include consent for sedation and cover best practice as outlined in the ESGE Position Statement for informed consent.Strong recommendation, very low certainty of evidence. ESGE and ESGENA recommend pre-assessment, a specific sedation regimen, and enhanced periprocedural monitoring in high-risk patients undergoing gastrointestinal procedures with sedation, to reduce the risk of sedation-related adverse events.Strong recommendation, very low certainty of evidence. ESGE and ESGENA recommend that pre-assessment, sedation regimen, and periprocedural monitoring should be determined by the complexity (duration, invasiveness) of the endoscopic procedure.Strong recommendation, very low certainty of evidence. ESGE and ESGENA suggest that the management of sedation in patients on glucagon-like peptide-1 receptor agonists should be individualized. Conditional recommendation, very low certainty of evidence. ESGE and ESGENA suggest offering the option of diagnostic colonoscopy and gastroscopy without sedation, based on the patient's and endoscopist's preference.Conditional recommendation, very low certainty of evidence. ESGE and ESGENA recommend that sedation should be provided by a dedicated healthcare professional trained in sedation administration and patient monitoring.Strong recommendation, very low certainty of evidence. ESGE and ESGENA recommend propofol for procedural sedation, as first line, depending on the country's human resources, service framework, and legislation.ESGE and ESGENA recommend midazolam for procedural sedation, in combination with opiates when analgesia is required.Strong recommendation, very low certainty of evidence. ESGE and ESGENA suggest the provision of the ultrashort-acting sedative remimazolam in elderly patients and patients with cardiovascular and/or respiratory comorbidities.Conditional recommendation, low certainty of evidence. ESGE and ESGENA suggest exercising caution when combining ultrashort-acting sedatives with other sedatives or analgesics.Conditional recommendation, low certainty of evidence. ESGE and ESGENA suggest capnography monitoring for patients undergoing sedated gastrointestinal endoscopy who are at higher risk of hypoxemia.Conditional recommendation, very low certainty of evidence. ESGE and ESGENA recommend that the use of reversal agents should be restricted to managing sedation-analgesia adverse events that do not improve with nonpharmacological intervention.Strong recommendation, very low certainty of evidence. ESGE and ESGENA recommend that patients be monitored after endoscopy by trained and qualified staff until the return of the patient's baseline observations.Strong recommendation, very low certainty of evidence. ESGE and ESGENA suggest using scoring systems and standardized discharge checklists to facilitate patient readiness for discharge. Assessments should include a detailed record of vital signs, pain levels, and psychomotor performance.Conditional recommendation, very low certainty of evidence. ESGE and ESGENA suggest that the performing endoscopist holds the overall medicolegal responsibility for the patient's treatment, including safe recovery, but may delegate the assessment and discharge to trained and qualified personnel based on standardized discharge criteria.Conditional recommendation, very low certainty of evidence. ESGE and ESGENA recommend that patients receive oral and written information regarding the post-endoscopy period. Contact details should be provided for potential delayed complications, emergencies, or readmission.ESGE and ESGENA recommend that patients undergoing sedated endoscopy have an accompanying person at discharge.Strong recommendation, very low certainty of evidence. ESGE and ESGENA recommend performing emergency endoscopy under moderate sedation in hemodynamically stable patients. Alternatively, emergency endoscopy without sedation in cooperative patients is feasible.ESGE and ESGENA recommend sedation administration by an anesthesiology specialist in emergency endoscopy in patients at increased risk of aspiration, or with hemodynamic instability or significant comorbidities.Strong recommendation, very low certainty of evidence. ESGE and ESGENA recommend consultation with anesthetic and obstetric teams involved in the pregnant patient`s care, together with the patient's choice for the appropriateness and choice of sedation during gastrointestinal endoscopy.Strong recommendation, very low certainty of evidence. ESGE and ESGENA recommend improving and expanding educational offerings on sedation strategies and the principles of airway management, using structured training.Strong recommendation, low certainty of evidence. ESGE and ESGENA recommend the development and implementation of a quality improvement program with performance indicators to monitor the quality of sedation practices in gastrointestinal endoscopy.Strong recommendation, very low certainty of evidence. ESGE and ESGENA recommend a rational use of sedatives to reduce the environmental impact of endoscopy.Strong recommendation, moderate certainty of evidence.