Intravenous Sedation for Endoscopy

Abstract

Gastrointestinal endoscopy has never been comfortable for patients. As it evolves, more complex, lengthy, and interventional procedures are performed, and patients prefer sedation to undergo endoscopy. Sedation needs to be adapted to the singularities of older adults, who essentially manifest a higher burden of comorbidities. They require lower doses of most usual sedatives required to reach an acceptable level of sedation while preserving safety. Endoscopy requires the whole range of the anesthetic spectrum, from superficial sedation to general anesthesia, a judicious selection of the type of sedation, the setting of the procedure, the sedation plan, and the drug utilized, as a prerequisite for endoscopy. When performed by endoscopists, midazolam and a sedative versus propofol-based sedation are the two main options. Anesthesiologists are required in some situations, and they must actively collaborate with the endoscopy team to provide the best sedation regime for each patient. Individual characteristics as well as local expertise and regulations are the key points to choose either option. Regardless of the particularities of older patients, general principles about sedation can be applied to most individuals.