8. SEDATION AND MONITORING

INTRODUCTION

Many diagnostic endoscopic procedures can be carried out without sedation using reassurance and oropharyngeal local anaesthesia. However, therapeutic endoscopy, particularly of the upper gastrointestinal tract, may be unpleasant and painful, and often requires adjunctive pain relief and sedation. In this chapter we examine the conduct of monitoring and sedation for therapeutic endoscopy.

Conscious sedation is "A technique in which the use of a drug or drugs produces a state
of depression of the central nervous system enabling treatment to be carried out, but during which verbal contact with the patient is maintained throughout the period of sedation.
The drugs and techniques used to provide conscious sedation should carry a margin of safety wide enough to render loss of consciousness unlikely"¹ . There are two recent key guidelines for sedation and monitoring. The British Society of Gastroenterology (BSG) guidelines ‘Safety and sedation during endoscopic procedures’² and the Academy of Medical Royal Colleges, ‘Implementing and ensuring safe sedation practice for healthcare procedures in adults’¹. All endoscopists and their assistants using sedation and monitoring patients should be familiar with these and a copy of each should be available to those in
the endoscopy suite.