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Background
Sedation is commonly used in gastrointestinal endoscopy; however, considerable variability in sedation practices has been reported. The objective of this review was to identify and synthesize existing recommendations on sedation practices for routine gastrointestinal endoscopy procedures.
Methods
We systematically reviewed guidelines and position statements identified through a search of PubMed, guidelines databases, and websites of relevant professional associations from January 1, 2005 to May 10, 2019. We included English-language guidelines/position statements with recommendations relating to sedation for adults undergoing routine gastrointestinal endoscopy. Documents with guidance only for complex endoscopic procedures were excluded.
We extracted and synthesized recommendations relating to: 1) choice of sedatives, 2) sedation administration, 3) personnel responsible for monitoring sedated patients, 4) skills and training of individuals involved in sedation, and 5) equipment required for monitoring sedated patients. We assessed the quality of included documents using the Appraisal of Guidelines for Research & Evaluation (AGREE) II tool.
Results
We identified 19 guidelines and 7 position statements meeting inclusion criteria. Documents generally agreed that a single, trained registered nurse can administer moderate sedation, monitor the patient, and assist with brief, interruptible tasks. Documents also agreed on the routine use of pulse oximetry and blood pressure monitoring during endoscopy. However, recommendations relating to the drugs to be used for sedation, the healthcare personnel capable of administering propofol and monitoring patients sedated with propofol, and the need for capnography when monitoring sedated patients varied. Only 9 documents provided a grade or level of evidence in support of their recommendations.
Conclusions
Recommendations for sedation practices in routine gastrointestinal endoscopy differ across guidelines/position statements and often lack supporting evidence with potential implications for patient safety and procedural efficiency.
Registration Number
CRD42019141076
Keywords
Endoscopy, digestive system, Sedatives, Guideline
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Peer Review Timeline
CURRENT STATUS: Published
View the published article at BMC Gastroenterology.
No community comments so far
Submission checks complete
On 29 Nov, 2020
Editorial decision: Accept
On 24 Nov, 2020
Version 2
Posted 03 Sep, 2020
No comments provided
Editorial decision: Major revision
On 27 Oct, 2020
Review #2 received
Received 18 Oct, 2020
Review #1 received
Received 06 Oct, 2020
Reviewer #2 agreed
On 01 Oct, 2020
Reviewer #1 agreed
On 29 Sep, 2020
Reviewers invited
Invitations sent on 25 Sep, 2020
Editor assigned
On 01 Sep, 2020
Submission checks complete
On 31 Aug, 2020
Editor invited
On 31 Aug, 2020
No comments provided
Editorial decision: Major revision
On 13 Aug, 2020
Review #5 received
Received 10 Aug, 2020
Review #2 received
Received 10 Aug, 2020
Review #3 received
Received 06 Aug, 2020
Reviewer #7 agreed
On 06 Aug, 2020
Review #7 received
Received 06 Aug, 2020
Reviewer #6 agreed
On 04 Aug, 2020
Reviewer #5 agreed
On 03 Aug, 2020
Review #1 received
Received 03 Aug, 2020
Reviewer #2 agreed
On 01 Aug, 2020
Reviewer #3 agreed
On 01 Aug, 2020
Reviewer #4 agreed
On 01 Aug, 2020
Editor assigned
On 01 Aug, 2020
Reviewers invited
Invitations sent on 01 Aug, 2020
Reviewer #1 agreed
On 01 Aug, 2020
Submission checks complete
On 31 Jul, 2020
Editor invited
On 30 Jul, 2020
First submitted
On 19 Jul, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Gastroenterology & Hepatology
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A new preprint design is coming!
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See the published version of this preprint at BMC Gastroenterology.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at BMC Gastroenterology.
No community comments so far
Submission checks complete
On 29 Nov, 2020
Editorial decision: Accept
On 24 Nov, 2020
Version 2
Posted 03 Sep, 2020
No comments provided
Editorial decision: Major revision
On 27 Oct, 2020
Review #2 received
Received 18 Oct, 2020
Review #1 received
Received 06 Oct, 2020
Reviewer #2 agreed
On 01 Oct, 2020
Reviewer #1 agreed
On 29 Sep, 2020
Reviewers invited
Invitations sent on 25 Sep, 2020
Editor assigned
On 01 Sep, 2020
Submission checks complete
On 31 Aug, 2020
Editor invited
On 31 Aug, 2020
No comments provided
Editorial decision: Major revision
On 13 Aug, 2020
Review #5 received
Received 10 Aug, 2020
Review #2 received
Received 10 Aug, 2020
Review #3 received
Received 06 Aug, 2020
Reviewer #7 agreed
On 06 Aug, 2020
Review #7 received
Received 06 Aug, 2020
Reviewer #6 agreed
On 04 Aug, 2020
Reviewer #5 agreed
On 03 Aug, 2020
Review #1 received
Received 03 Aug, 2020
Reviewer #2 agreed
On 01 Aug, 2020
Reviewer #3 agreed
On 01 Aug, 2020
Reviewer #4 agreed
On 01 Aug, 2020
Editor assigned
On 01 Aug, 2020
Reviewers invited
Invitations sent on 01 Aug, 2020
Reviewer #1 agreed
On 01 Aug, 2020
Submission checks complete
On 31 Jul, 2020
Editor invited
On 30 Jul, 2020
First submitted
On 19 Jul, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Gastroenterology & Hepatology
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at BMC Gastroenterology.
Background
Sedation is commonly used in gastrointestinal endoscopy; however, considerable variability in sedation practices has been reported. The objective of this review was to identify and synthesize existing recommendations on sedation practices for routine gastrointestinal endoscopy procedures.
Methods
We systematically reviewed guidelines and position statements identified through a search of PubMed, guidelines databases, and websites of relevant professional associations from January 1, 2005 to May 10, 2019. We included English-language guidelines/position statements with recommendations relating to sedation for adults undergoing routine gastrointestinal endoscopy. Documents with guidance only for complex endoscopic procedures were excluded.
We extracted and synthesized recommendations relating to: 1) choice of sedatives, 2) sedation administration, 3) personnel responsible for monitoring sedated patients, 4) skills and training of individuals involved in sedation, and 5) equipment required for monitoring sedated patients. We assessed the quality of included documents using the Appraisal of Guidelines for Research & Evaluation (AGREE) II tool.
Results
We identified 19 guidelines and 7 position statements meeting inclusion criteria. Documents generally agreed that a single, trained registered nurse can administer moderate sedation, monitor the patient, and assist with brief, interruptible tasks. Documents also agreed on the routine use of pulse oximetry and blood pressure monitoring during endoscopy. However, recommendations relating to the drugs to be used for sedation, the healthcare personnel capable of administering propofol and monitoring patients sedated with propofol, and the need for capnography when monitoring sedated patients varied. Only 9 documents provided a grade or level of evidence in support of their recommendations.
Conclusions
Recommendations for sedation practices in routine gastrointestinal endoscopy differ across guidelines/position statements and often lack supporting evidence with potential implications for patient safety and procedural efficiency.
Registration Number
CRD42019141076
Figure 1
This is a list of supplementary files associated with this preprint. Click to download.
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