Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Aug 2007
ReviewSedation for gastrointestinal endoscopy: the changing landscape.
Most patients require sedation for gastrointestinal endoscopy. Moderate sedation for these procedures has traditionally been provided by the endoscopist with benzodiazepine and/or a narcotic. As endoscopy has increased in numbers and complexity, however, more effective sedation and analgesia is frequently required. Controversy has ensued over safe and efficient sedation practice. This review seeks to delineate what has been learned about this topic in the recent literature. ⋯ Alternatives to anesthesiologist-supervised propofol include nurse-administered propofol sedation supervised by the endoscopist, and patient controlled sedation. While other sedative regimens continue to be examined, the use of propofol for gastrointestinal endoscopy will continue to increase. Structured nurse-administered propofol programs appear to be safe, but the occurrence of severe respiratory depression and the ability to rescue remain concerns. Further study into appropriate sedation training, patient selection, ability to rescue, complications and value of anesthesiologist-directed sedation is necessary.
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The recent year's literature is reviewed concerning the use of sedation in the emergency department. The use of moderate to deep sedation is becoming common in emergency medicine for many reasons, including progressive hospital crowding, limited availability of anesthesia, and increased training in residency. This is performed for a wide variety of procedures, most commonly orthopedic. ⋯ The year's literature reflects the reality that the performance of sedation in the emergency department is advantageous. As the era of evidence-based medicine continues to provide us with more and better information, the combined efforts of both anesthesiology and emergency medicine can hopefully contribute to improving patient safety with respect to procedural sedation.