Digestive Diseases and Sciences

, Volume 57, Issue 10, pp 2527–2534 | Cite as

What Factors Are Associated with the Difficult-to-Sedate Endoscopy Patient?

  • Bikram S. BalEmail author
  • Michael D. Crowell
  • Divyanshoo R. Kohli
  • Jiana Menendez
  • Farzin Rashti
  • Anjali S. Kumar
  • Kevin W. Olden
Original Article



Difficult sedation during endoscopy results in inadequate examinations and aborted procedures. We hypothesized that gender, alcohol abuse, physical/sexual abuse, and anxiety are predictors of difficult-to-sedate endoscopy patients.


This is a prospective cohort study. At the time of enrollment, subjects completed the following three validated questionnaires: state-trait anxiety inventory, self-report version of alcohol use disorder inventory, and Drossman questionnaire for physical/sexual abuse. Conscious sedation was administered for the endoscopic procedures at the discretion of the endoscopist and was graded in accordance with the Richmond agitation sedation scale (RASS). Subjects’ perceptions of sedation were documented on a four-point Likert scale 24 h after their procedure.


One-hundred and forty-three (79 %) of the 180 subjects enrolled completed the study. On the basis of the RASS score, 56 (39 %) subjects were found to be difficult to sedate of which only five were dissatisfied with their sedation experience. State (n = 39; p = 0.003) and trait (n = 41; p = 0.008) anxiety and chronic psychotropic use (p = 0.040) were associated with difficult sedation. No association was found between difficult sedation and gender (p = 0.77), alcohol abuse (p = 0.11), sexual abuse (p = 0.15), physical abuse (p = 0.72), chronic opioid use (p = 0.16), or benzodiazepines (BDZ) use (p = 0.10).


Pre-procedural state or trait anxiety is associated with difficult sedation during endoscopy. In this study neither alcohol abuse nor chronic opiate/BDZ use was associated with difficult sedation.


Endoscopy Difficult to sedate Abuse Anxiety 


Conflict of interest

No conflict of interest.


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Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Bikram S. Bal
    • 1
    Email author
  • Michael D. Crowell
    • 3
  • Divyanshoo R. Kohli
    • 1
  • Jiana Menendez
    • 4
  • Farzin Rashti
    • 1
  • Anjali S. Kumar
    • 5
  • Kevin W. Olden
    • 2
    • 6
  1. 1.Division of Gastroenterology, Department of Internal MedicineWashington Hospital CenterWashingtonUSA
  2. 2.Department of MedicineSt Joseph’s Hospital and Medical CenterPhoenixUSA
  3. 3.Division of Gastroenterology and HepatologyMayo ClinicScottsdaleUSA
  4. 4.Mount Sinai Medical SchoolNew YorkUSA
  5. 5.Department of SurgeryWashington Hospital CenterWashingtonUSA
  6. 6.Department of Medicine and PsychiatryCreighton University School of MedicineOmahaUSA

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