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September 1, 2008

Sedation Practice for Northeast Digestive Health Center

The goals of endoscopic sedation are to reduce anxiety, produce sedation/hypnosis and control discomfort. During moderate sedation the emphasis is on relief from anxiety and analgesia. In deep sedation it is hypnosis. In both instances we rely upon the amnesic effect of sedative agents to improve the patient’s perception and recall of the endoscopic experience.

Benzodiazepines are the sedative and anti-anxiety agents of choice. Their advantages include 1: excellent anxiety relief and sedation. 2: wide therapeutic margin, 3: No emetic effect and 4: excellent ante grade amnesia.

Midazolam (Versed) is the most popular benzodiazepine for intravenous use and is the one we routinely use.

The opioid narcotics are potent analgesics with mild sedative properities’. Meperidine and Fentanyl are the two most commonly used narcotics for intravenous use in endoscopy. Fentanyl has largely replaced Meperidine (Demerol) due to its better side effect profile.

At the Northeast Digestive Health Center we generally us a combination of Midazolam and Fentanyl for moderate sedation.

Propofol is an ultra-short acting sedative hypnotic agent with little or no analgesic activity. It is particularly useful in patients that may be difficult to sedate or who require deep sedation.

Patients difficult to sedate are generally those who are taking anti-depressants, sedatives, minor tranquilizers, sleeping agents or narcotic analgesics on a regular basis.

We currently offer Propofol at CMC-Northeast hospital endoscopy and at the Gateway Surgery Center.
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