Steven Lippmann
University of Louisville, USA
Posters & Accepted Abstracts: J Hepatol Gastroint Dis
Sedation/analgesia is a widely applied pharmaceutical approach to facilitate endoscopies. However, procedural or conscious sedation is not always required or even desired. Designed to decrease pain and anxiety, many endoscopies can safely, easily and comfortably be performed without sedatives or analgesics. Most lay people are unaware that sedation-free endoscopy is an option; many physicians prefer applying sedation often with analgesia when performing such procedures. However, without these pharmaceuticals there are fewer cardiopulmonary complications and virtually no cognitive concerns. With some irony, doctors often prefer to be drug-free when they, themselves, undergo such procedures. Sedation and/or analgesia increase the risks and types of side effects. These medications also significantly add to cost, duration, recovery time, physician presence and recovery room utilization. Nevertheless, such pharmacotherapies are warranted for some patients, like those with cognitive impairment, children, less well controlled persons and/or whenever discomfort levels are high, like in complicated cases. The USA is an exception to the otherwise usual absence of sedation during endoscopies. Despite the majority of cases performed under pre-procedure medication, there is support for selected, appropriate individuals to undergo procedures like these without sedation or analgesia. Physicians should consider and also offer ??sedation-free? endoscopy, ??sedation-on-demand? procedures and/or utilizing calmative pharmaceuticals only whenever it is specifically indicated. Some patients like to specify the degree of sedation they wish to accept. For safety and financial reasons, doctors are encouraged to offer well-informed patients the option of sedation-free endoscopy whenever indicated. Medication can later be added at patient request and/or physician discretion. Topical, pharyngeal anesthesia is an accepted practice during upper endoscopies, since it diminishes the gag reflex and does not yield sedation or compromise of cognition. Sedation-free endoscopy is well-tolerated and not consistently worth the increased risk involved, especially since the endoscopy discomfort is brief, as compared to an often longer-duration of many procedurallyfacilitating drugs. Additionally, the non-sedated patient is in a cognitive state for discussion with the physician during or even immediately after the procedure. Beyond avoiding many potential adversities, sedation-free procedures have the benefit of the patient being able to follow instructions and be fully awake and of decisional capacity throughout and after the procedure. They are thus also alert and able to drive, return to other activities and/or discuss finding, results, or follow-up plans with the doctor. The same applies when topical-only pharyngeal analgesia is administered. Patients should have the option of selectively skipping sedation or receiving it later, if needed. Prescribing sedation on an as indicated basis yields benefits to patients, finances and endoscopists.
E-mail: sblipp01@louisville.edu
