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2021 Korean Society of Gastrointestinal Endoscopy Clinical Practice Guidelines for Endoscopic Sedation

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Sedation can resolve anxiety and fear in patients undergoing endoscopy. The use of sedatives has increased in Korea. Appropriate sedation is a state in which the patient feels subjectively comfortable while maintaining the airway reflex for stable spontaneous breathing. The patient should maintain a state of consciousness to the extent that he or she can cooperate with the needs of the medical staff. Despite its benefits, endoscopic sedation has been associated with cardiopulmonary complications. Such cardiopulmonary complications are usually temporary, and most patients recover without sequelae. However, these events may progress to serious complications, such as cardiovascular collapse. Therefore, it is essential to screen high-risk patients before sedation and reduce complications by meticulous monitoring. Additionally, physicians should be familiar with the management of emergencies. The first Korean clinical practice guideline for endoscopic sedation was developed based on previous worldwide guidelines for endoscopic sedation using an adaptation process. The guideline consists of nine recommendations based on a critical review of currently available data and expert consensus when the guideline was drafted. These guidelines should provide clinicians, nurses, medical school students, and policy makers with information on how to perform endoscopic sedation with minimal risk.

Abstract

Sedation can resolve anxiety and fear in patients undergoing endoscopy. The use of sedatives has increased in Korea. Appropriate sedation is a state in which the patient feels subjectively comfortable while maintaining the airway reflex for stable spontaneous breathing. The patient should maintain a state of consciousness to the extent that he or she can cooperate with the needs of the medical staff. Despite its benefits, endoscopic sedation has been associated with cardiopulmonary complications. Such cardiopulmonary complications are usually temporary, and most patients recover without sequelae. However, these events may progress to serious complications, such as cardiovascular collapse. Therefore, it is essential to screen high-risk patients before sedation and reduce complications by meticulous monitoring. Additionally, physicians should be familiar with the management of emergencies. The first Korean clinical practice guideline for endoscopic sedation was developed based on previous worldwide guidelines for endoscopic sedation using an adaptation process. The guideline consists of nine recommendations based on a critical review of currently available data and expert consensus when the guideline was drafted. These guidelines should provide clinicians, nurses, medical school students, and policy makers with information on how to perform endoscopic sedation with minimal risk.

참고문헌 (85)

  1. Dumonceau JM, "European curriculum for sedation training in gastrointestinal endoscopy : position statement of the European Society of Gastrointestinal Endoscopy(ESGE)and European Society of Gastroenterology and Endoscopy Nurses and Associates(ESGENA)", Endoscopy, 45, pp.496~504 (2013)
  2. Gotoda T, "Guidelines for sedation in gastroenterological endoscopy(second edition)", Dig Endosc, 33, pp.21~53 (2021)
  3. American Association for Study of Liver Diseases, "Multisociety sedation curriculum for gastrointestinal endoscopy", Gastrointest Endosc, 76, pp.e1~e25 (2012)
  4. Schilling D, "Impact of S3 training courses"Sedation and Emergency Management in Endoscopy for Endoscopy Nurses and Assisting Personnel"on the process and structure quality in gastroenterological endoscopy in practices and clinics : results of a nationwide survey", Z Gastroenterol, 51, pp.619~627 (2013)
  5. Berzin TM, "A prospective assessment of sedation-related adverse events and patient and endoscopist satisfaction in ERCP with anesthesiologistadministered sedation", Gastrointest Endosc, 73, pp.710~717 (2011)
  6. Qadeer MA, "Hypoxemia during moderate sedation for gastrointestinal endoscopy : causes and associations", Digestion, 84, pp.37~45 (2011)
  7. Frieling T, "Sedation-associated complications in endoscopy : prospective multicentre survey of 191142 patients", Z Gastroenterol, 51, pp.568~572 (2013)
  8. Wani S, "Obesity as a risk factor for sedation-related complications during propofol-mediated sedation for advanced endoscopic procedures", Gastrointest Endosc, 74, pp.1238~1247 (2011)
  9. Mador MJ, "Do patients at risk of sleep apnea have an increased risk of cardio-respiratory complications during endoscopy procedures", Sleep Breath, 16, pp.609~615 (2012)
  10. Dumonceau JM, "Non-anesthesiologist administration of propofol for gastrointestinal endoscopy : European Society of Gastrointestinal Endoscopy, European Society of Gastroenterology and Endoscopy Nurses and Associates Guideline : updated June 2015", Endoscopy, 47, pp.1175~1189 (2015)
  11. ASGE Standards of Practice Committee, "Guidelines for sedation and anesthesia in GI endoscopy", Gastrointest Endosc, 87, pp.327~337 (2018)
  12. Friedrich K, "Endoscopist-administered propofol sedation is safe : a prospective evaluation of 10, 000patients in an outpatient practice", J Gastrointestin Liver Dis, 21, pp.259~263 (2012)
  13. Kim SY, "Impacts of age and sedation on cardiocerebrovascular adverse events after diagnostic GI endoscopy : a nationwide population-based study", Gastrointest Endosc, 92, pp.591~602 (2020)
  14. Mehta PP, "Can a validated sleep apnea scoring system predict cardiopulmonary events using propofol sedation for routine EGD or colonoscopy? A prospective cohort study", Gastrointest Endosc, 79, pp.436~444 (2014)
  15. Cha JM, "Risk of sedation for diagnostic esophagogastroduodenoscopy in obstructive sleep apnea patients", World J Gastroenterol, 19, pp.4745~4751 (2013)
  16. Hinkelbein J, "European Society of Anaesthesiology and European Board of Anaesthesiology guidelines for procedural sedation and analgesia in adults", Eur J Anaesthesiol, 35, pp.6~24 (2018)
  17. Mallampati SR, "A clinical sign to predict difficult tracheal intubation : a prospective study", Can Anaesth Soc J, 32, pp.429~434 (1985)
  18. Dietrich CG, "Sedation-associated complications in endoscopy are not reduced significantly by implementation of the German S-3-guideline and occur in a severe manner only in patients with ASA class III and higher", Scand J Gastroenterol, 48, pp.1082~1087 (2013)
  19. Enestvedt BK, "Is the American Society of Anesthesiologists classification useful in risk stratification for endoscopic procedures", Gastrointest Endosc, 77, pp.464~471 (2013)
  20. Muravchick S, "The elderly outpatient : current anesthetic implications", Curr Opin Anaesthesiol, 15, pp.621~625 (2002)
  21. Boss GR, "Age-related physiological changes and their clinical significance", West J Med, 135, pp.434~440 (1981)
  22. Shaker R, "Pharyngoglottal closure reflex : characterization in healthy young, elderly and dysphagic patients with predeglutitive aspiration", Gerontology, 49, pp.12~20 (2003)
  23. Lukens FJ, "Colonoscopy in octogenarians : a prospective outpatient study", Am J Gastroenterol, 97, pp.1722~1725 (2002)
  24. ASGE Standards of Practice Committee, "Modifications in endoscopic practice for the elderly", Gastrointest Endosc, 78, pp.1~7 (2013)
  25. Darling E, "Practical considerations in sedating the elderly", Crit Care Nurs Clin North Am, 9, pp.371~380 (1997)
  26. Peacock JE, "Effect of different rates of infusion of propofol for induction of anaesthesia in elderly patients", Br J Anaesth, 65, pp.346~352 (1990)
  27. Horiuchi A, "Propofol sedation for endoscopic procedures in patients 90 years of age and older", Digestion, 78, pp.20~23 (2008)
  28. Heuss LT, "Conscious sedation with propofol in elderly patients : a prospective evaluation", Aliment Pharmacol Ther, 17, pp.1493~1501 (2003)
  29. Bell GD, "Intravenous midazolam for upper gastrointestinal endoscopy : a study of 800 consecutive cases relating dose to age and sex of patient", Br J Clin Pharmacol, 23, pp.241~243 (1987)
  30. Cha JM, "Risks and benefits of colonoscopy in patients 90 years or older, compared with younger patients", Clin Gastroenterol Hepatol, 14, pp.80~86 (2016)
  31. Kazama T, "Optimal propofol plasma concentration during upper gastrointestinal endoscopy in young, middle-aged, and elderly patients", Anesthesiology, 93, pp.662~669 (2000)
  32. Martínez JF, "Safety of continuous propofol sedation for endoscopic procedures in elderly patients", Rev Esp Enferm Dig, 103, pp.76~82 (2011)
  33. Hayee B, "Midazolam with meperidine or fentanyl for colonoscopy : results of a randomized trial", Gastrointest Endosc, 69(3 Pt 2), pp.681~687 (2009)
  34. Cohen LB, "Moderate level sedation during endoscopy : a prospective study using low-dose propofol, meperidine", fentanyl, and midazolam, 2004, pp.59, 795~803
  35. "Clinical recommendations for propofol-based sedation for physicians in Korean healthcare clinics and hospitals" (2016)[URL]
  36. Cohen LB, "Propofol for endoscopic sedation : a protocol for safe and effective administration by the gastroenterologist", Gastrointest Endosc, 58, pp.725~732 (2003)
  37. Fatima H, "Nurse-administered propofol sedation for upper endoscopic ultrasonography", Am J Gastroenterol, 103, pp.1649~1656 (2008)
  38. Heuss LT, "Nonanesthesiologistadministered propofol sedation : from the exception to standard practice : sedation and monitoring trends over 20 years", Endoscopy, 44, pp.504~511 (2012)
  39. Jensen JT, "Nurse-administered propofol sedation for endoscopy : a risk analysis during an implementation phase", Endoscopy, 43, pp.716~722 (2011)
  40. Daza JF, "Propofol administration by endoscopists versus anesthesiologists in gastrointestinal endoscopy : a systematic review and meta-analysis of patient safety outcomes", Can J Surg, 61, pp.226~236 (2018)
  41. Külling D, "Propofol sedation during endoscopic procedures : how much staffand monitoring are necessary", Gastrointest Endosc, 66, pp.443~449 (2007)
  42. Vargo JJ, "Patient safety during sedation by anesthesia professionals during routine upper endoscopy and colonoscopy : an analysis of 1. 38 million procedures", Gastrointest Endosc, 85, pp.101~108 (2017)
  43. Khiani VS, "Anesthesiologist involvement in screening colonoscopy : temporal trends and cost implications in the Medicare population", Clin Gastroenterol Hepatol, 10, pp.58~64 (2012)
  44. Cooper GS, "Complications following colonoscopy with anesthesia assistance : a population-based analysis", JAMA Intern Med, 173, pp.551~556 (2013)
  45. Wernli KJ, "Risks associated with anesthesia services during colonoscopy", Gastroenterology, 150, pp.888~894 (2016)
  46. "Practice Guidelines for Moderate Procedural Sedation and Analgesia 2018: a report by the American Society of Anesthesiologists Task Force on Moderate Procedural Sedation and Analgesia, the American Association of Oral and Maxillofacial Surgeons, American College of Radiology, American Dental Association, American Society of Dentist Anesthesiologists, and Society of Interventional Radiology", Anesthesiology, 128, pp.437~479 (2018)
  47. Dumonceau JM, "European Society of Gastrointestinal Endoscopy, European Society of Gastroenterology and Endoscopy Nurses and Associates, and the European Society of Anaesthesiology Guideline : non-anesthesiologist administration of propofol for GI endoscopy", Endoscopy, 42, pp.960~974 (2010)
  48. Riphaus A, "Propofol, the preferred sedation for screening colonoscopy, is underused : results of an international survey", Dig Liver Dis, 44, pp.389~392 (2012)
  49. 이창균, "Room for Quality Improvement in Endoscopist-Directed Sedation: Results from the First Nationwide Survey in Korea", Gut and Liver, 10(1), pp.83~94 (2016), 거트앤리버 소화기연관학회협의회
  50. Bell GD, "Prevention of hypoxaemia during upper-gastrointestinal endoscopy by means of oxygen via nasal cannulae", Lancet, 1, pp.1022~1024 (1987)
  51. Bell GD, "Upper gastrointestinal endoscopy : a prospective randomized study comparing continuous supplemental oxygen via the nasal or oral route", Gastrointest Endosc, 38, pp.319~325 (1992)
  52. Bowling TE, "Effects of supplemental oxygen on cardiac rhythm during upper gastrointestinal endoscopy : a randomised controlled double blind trial", Gut, 34, pp.1492~1497 (1993)
  53. Crantock L, "Supplemental low flow oxygen prevents hypoxia during endoscopic cholangiopancreatography", Gastrointest Endosc, 38, pp.418~420 (1992)
  54. Zuccaro G, "Routine use of supplemental oxygen prevents recognition of prolonged apnea during endoscopy", Gastrointest Endosc, 51(Issue 4, Part 2), pp.AB141~ (2000)
  55. Griffin SM, "Effect of intranasal oxygen on hypoxia and tachycardia during endoscopic cholangiopancreatography", BMJ, 300, pp.83~84 (1990)
  56. Gross JB, "Nasal oxygen alleviates hypoxemia in colonoscopy patients sedated with midazolam and meperidine", Gastrointest Endosc, 36, pp.26~29 (1990)
  57. Haines DJ, "Does nasal oxygen reduce the cardiorespiratory problems experienced by elderly patients undergoing endoscopic retrograde cholangiopancreatography", Gut, 33, pp.973~975 (1992)
  58. Iwao T, "Supplemental oxygen during endoscopic variceal ligation : effects on arterial oxygenation and cardiac arrhythmia", Am J Gastroenterol, 90, pp.2186~2190 (1995)
  59. Jurell KR, "Effect of supplemental oxygen on cardiopulmonary changes during gastrointestinal endoscopy", Gastrointest Endosc, 40, pp.665~670 (1994)
  60. Kim H, "Oxygenation before endoscopic sedation reduces the hypoxic event during endoscopy in elderly patients : a randomized controlled trial", J Clin Med, 9, pp.E3282~ (2020)
  61. Patterson KW, "Hypoxemia during outpatient gastrointestinal endoscopy : the effects of sedation and supplemental oxygen", J Clin Anesth, 7, pp.136~140 (1995)
  62. Rozario L, "Supplemental oxygen during moderate sedation and the occurrence of clinically significant desaturation during endoscopic procedures", Gastroenterol Nurs, 31, pp.281~285 (2008)
  63. Standards of Practice Committee of the American Society for Gastrointestinal Endoscopy, "Sedation and anesthesia in GI endoscopy", Gastrointest Endosc, 68, pp.815~826 (2008)
  64. American Society of Anesthesiologists Task Force on Sedation, "Practice guidelines for sedation and analgesia by non-anesthesiologists", Anesthesiology, 96, pp.1004~1017 (2002)
  65. ASGE Ensuring Safety in the Gastrointestinal Endoscopy Unit Task Force, "Guidelines for safety in the gastrointestinal endoscopy unit", Gastrointest Endosc, 79, pp.363~372 (2014)
  66. Cohen LB, "AGA Institute review of endoscopic sedation", Gastroenterology, 133, pp.675~701 (2007)
  67. Waring JP, "Guidelines for conscious sedation and monitoring during gastrointestinal endoscopy", Gastrointest Endosc, 58, pp.317~322 (2003)
  68. Maurer WG, "Basic requirements for monitoring sedated patients : blood pressure, pulse oximetry, and EKG", Digestion, 82, pp.87~89 (2010)
  69. Lucendo AJ, "Gastrointestinal endoscopy sedation and monitoring practices in Spain : a nationwide survey in the year 2014", Endoscopy, 47, pp.383~390 (2015)
  70. Riphaus A, "Endoscopic sedation and monitoring practice in Germany : results from the first nationwide survey", Z Gastroenterol, 48, pp.392~397 (2010)
  71. Willey J, "Quantitative assessment of psychomotor recovery after sedation and analgesia for outpatient EGD", Gastrointest Endosc, 56, pp.810~816 (2002)
  72. Aldrete JA, "Modifications to the postanesthesia score for use in ambulatory surgery", J Perianesth Nurs, 13, pp.148~155 (1998)
  73. Aldrete JA, "A postanesthetic recovery score", Anesth Analg, 49, pp.924~934 (1970)
  74. Chung F, "Are discharge criteria changing?", J Clin Anesth, 5(6 Suppl 1), pp.64S~68S (1993)
  75. Chung F, "A post-anesthetic discharge scoring system for home readiness after ambulatory surgery", J Clin Anesth, 7, pp.500~506 (1995)
  76. Amornyotin S, "Recovery pattern and home-readiness after ambulatory gastrointestinal endoscopy", J Med Assoc Thai, 90, pp.2352~2358 (2007)
  77. Trevisani L, "Post-Anaesthetic Discharge Scoring System to assess patient recovery and discharge after colonoscopy", World J Gastrointest Endosc, 5, pp.502~507 (2013)
  78. Gurunathan U, "Effect of midazolam in addition to propofol and opiate sedation on the quality of recovery after colonoscopy : a randomized clinical trial", Anesth Analg, 131, pp.741~750 (2020)
  79. Thompson R, "Comparison of the effects of midazolam", fentanyl, midazolam, fentanyl, pp.propofol on cognitive function after gastrointestinal endoscopy, Surg Laparosc Endosc Percutan Tech[DOI]
  80. Zhang K, "Safety and efficacy of propofol alone or in combination with other agents for sedation of patients undergoing colonoscopy : an updated meta-analysis", Eur Rev Med Pharmacol Sci, 24, pp.4506~4518 (2020)
  81. Hsu YH, "Evident cognitive impairments in seemingly recovered patients after midazolam-based light sedation during diagnostic endoscopy", J Formos Med Assoc, 114, pp.489~497 (2015)
  82. Horiuchi A, "Low-dose propofol sedation for diagnostic esophagogastroduodenoscopy : results in 10, 662 adults", Am J Gastroenterol, 104, pp.1650~1655 (2009)
  83. Horiuchi A, "Psychomotor recovery and blood propofol level in colonoscopy when using propofol sedation", Gastrointest Endosc, 75, pp.506~512 (2012)
  84. Horiuchi A, "Safety and effectiveness of propofol sedation during and after outpatient colonoscopy", World J Gastroenterol, 18, pp.3420~3425 (2012)
  85. Watkins TJ, "Evaluation of postprocedure cognitive function using 3 distinct standard sedation regimens for endoscopic procedures", AANA J, 82, pp.133~139 (2014)

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