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Anesthesia or sedation for gastroenterologic endoscopies

Luginbühl, Martin; Vuilleumier, Pascal; Schumacher, Peter; Stüber, Frank

Current Opinion in Anesthesiology: August 2009 - Volume 22 - Issue 4 - p 524–531
doi: 10.1097/ACO.0b013e32832dbb7c
Anesthesia outside the operating room: Edited by Alwin E. Goetz

Purpose of review Because propofol is the sedative preferred by gastroenterologists, we focus this review on gastroenterologist-directed propofol sedation, provide simulations of the respiratory depressant effect of different dosing protocols and give a perspective on future developments in computer-assisted sedation techniques.

Recent findings Propofol use by nonanesthesiologists remains a contraindication in the package insert of propofol in most countries. Sedation guidelines produced by the American Society of Gastroenterology partially contradict those produced by the American Society of Anesthesiologists for sedation by nonanesthesiologists, whereas the German guidelines were developed with anesthesiologists involved. The use of fospropofol, recently approved by the US Food and Drug Administration for sedation, is considered an alternative to propofol by some gastroenterologists. Methodological errors in earlier pharmacological studies have to be solved before widespread use of fospropofol is justified, however. Our simulations show that dosing protocols with small boluses administered at reasonable intervals induce less respiratory depression than large boluses. Interindividual variability of propofol-induced respiratory depression is illustrated by different pharmacokinetic and dynamic parameter sets used in the simulation. Two computer-assisted propofol infusion systems are currently being investigated. They not only incorporate the target effect but also the side effects, which may limit respiratory depression.

Summary Propofol use by gastroenterologists may be well tolerated if appropriate patient selection, staff training, monitoring and low-dose sedation protocols are applied.

Department of Anaesthesiology, University Hospital of Bern, Bern, Switzerland

Correspondence to PD Dr med. Martin Luginbühl, Consultant Anaesthesiologist, Department of Anaesthesiology, University Hospital, CH-3010 Bern, Switzerland Tel: +41 31 632 27 19; fax: +41 31 632 05 54; e-mail: martin.luginbuehl@dkf.unibe.ch

© 2009 Lippincott Williams & Wilkins, Inc.