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AGA: sedation safe for endoscopic procedures The use of an evidence-based sedation protocol for endoscopic procedures improves the quality of practice and reduces the incidence of sedation-related adverse events, according to a study co-authored by MUSC’s Mark DeLegge, M.D., and published in the August issue of Gastroenterology, the official journal of the American Gastroenterological Association (AGA) Institute.   “The AGA Institute supports the administration of sedation by gastroenterologists performing endo-scopic procedures on average risk patients, provided that they have proper training and experience,” said Nicholas LaRusso, M.D., president, AGA Institute. “Patients should feel comfortable undergoing an endoscopic procedure, including the administration of intravenous sedation, by a gastroenterologist who is trained and licensed.”   The use of sedation during endoscopic procedures, including colonoscopies and upper endoscopies, is considered a medical necessity by gastroenterologists, with more than 98 percent utilizing sedation during these procedures. By reducing a patient’s anxiety and discomfort during the procedure, gastroenterologists are able to better ensure that they are performing a thorough exam while minimizing the patient’s risk of injury and improving their tolerability, according to the study titled AGA Institute Review of Endoscopic Sedation.   “Due to the widespread use of sedation during endoscopy procedures, it is of great importance that gastro-enterologists implement sedation protocols in their practices to improve the quality of practice and minimize the risk of sedation-related adverse events,” said Lawrence Cohen, M.D., associate clinical professor at The Mount Sinai Hospital, New York, and co-author of the paper.   But DeLegge urges continued review of methods used for sedation to assure their safety.   “Efforts are ongoing to improve endoscopic sedation, including the evaluation of new drugs and the re-assessment of current agents, as well as the development of new methods of delivery,” said Delegge, director, Digestive Disease Center and Section of Nutrition; and professor of medicine. “While there are several promising prospects on the horizon, we must make every effort to ensure that our procedures are safe and well tolerated with the agents that are currently available to us.”   The review was based on an evidence-based analysis of the literature, whenever possible. In areas in which evidence from controlled studies was absent, data from case series, retrospective database studies and expert opinions in endoscopy and anesthesia were used.     The AGA Institute Review generated 16 summary statements and recommen-dations on the use of sedation in endoscopies. A few of them were: Pre-procedure patient evaluations should be performed and documented prior to endoscopy procedures to enable gastroenterologists to identify pertinent patient history and physical findings that may affect sedation outcomes. Use of an anesthesia professional should be considered during endoscopy procedures including patients with patients with severe systemic disease or patients who are morbid or at substantial risk of death, and patients with a history of being difficult to sedate Endoscopists should be familiar with the unique pharmacologic properties of all agents used for sedation and reversal during the procedures, including time of onset, peak response, duration of effect, patient variations in responsiveness to the drugs and potential drug-drug interactions. Medical professionals who administer sedation should possess the ability to recognize and rescue patients who fall into a level of sedation deeper than originally intended. New methods of monitoring are currently undergoing clinical evalua-tion. Their routine use for moderate sedation cannot be recommended currently based upon the available literature. These methods include capnography, a noninvasive technique to measure CO2 in expired gases, and a noninvasive method of assessing a patient’s level of consciousness. Endoscopists’ training for sedation should emphasize an understanding of medications used for endoscopic sedation and the skills necessary for the diagnosis and treatment of cardio-pulmonary complication as well as current certification in advanced cardiac life support (ACLS). Friday, Aug. 10, 2007 Catalyst Online is published weekly, updated as needed and improved from time to time by the MUSC Office of Public Relations for the faculty, employees and students of the Medical University of South Carolina. Catalyst Online editor, Kim Draughn, can be reached at 792-4107 or by email, catalyst@musc.edu. Editorial copy can be submitted to Catalyst Online and to The Catalyst in print by fax, 792-6723, or by email to catalyst@musc.edu. To place an ad in The Catalyst hardcopy, call Island Publications at 849-1778, ext. 201.