Discharge following endoscopic sedation procedures: an implementation of an evidence-based protocol / 中国实用护理杂志

Objective To promote best discharge practice in sedated patients′ following endoscopic procedures in an endoscopy center in Shanghai, China. Methods A clinical audit was undertaken using the Joanna Briggs Institute Practical Application of Clinical Evidence System tool. Eight audit criteria that were representative of best practice recommendations for discharge following endoscopic sedation procedures were used. A baseline audit was conducted followed by the implementation of multiple strategies, determined by the key stakeholders. The project was finalized with a follow-up audit to determine change in practice. Results Improvements in practice were observed for all eight criteria. The most significant improvements were in the following: completion of an organizational policy, the minimum discharge criteria, patient has met minimum discharge criteria before being discharged (all from 0% to 100% compliance), and giving verbal and written instructions (from 12% to 100% compliance). Criteria 4 (the authority to discharge), 6 (staff training and education) and 7 (being accompanied by family) achieved the least improvement in compliance rates, as baseline measures already showed a high degree of compliance. The compliance rate for criterion 8 (medical file) attained 88%. Conclusion This protocol utilized a clinical audit process leading to improvements in practice behavior related to patient discharge following endoscopic sedation procedures. A continuous cycle of audit and re-audit will be required in the future to maintain high quality standards.

Updates on the Sedation for Gastrointestinal Endoscopy

Sedation, defined as the depressed level of consciousness, induced by drug administration, is widely used for gastrointestinal endoscopy to relieve a patient’s anxiety and discomfort. In addition, successful procedure is anticipated with control of unintended movements. Endoscopic sedation, however, cannot be free from the risk of serious adverse events, e.g., cardiopulmonary compromise. Therefore, principles on personnel, facility and equipment, as well as performance itself, should be followed to prevent unfavorable incidents. In this article, sedation guidelines for the Accreditation of Qualified Endoscopy Units, issued by the Korean Society of Gastrointestinal Endoscopy, are presented.

Discharge following endoscopic sedation procedures: an implementation of an evidence-based protocol / 中国实用护理杂志

Objective@#To promote best discharge practice in sedated patients′ following endoscopic procedures in an endoscopy center in Shanghai, China.@*Methods@#A clinical audit was undertaken using the Joanna Briggs Institute Practical Application of Clinical Evidence System tool. Eight audit criteria that were representative of best practice recommendations for discharge following endoscopic sedation procedures were used. A baseline audit was conducted followed by the implementation of multiple strategies, determined by the key stakeholders. The project was finalized with a follow-up audit to determine change in practice.@*Results@#Improvements in practice were observed for all eight criteria. The most significant improvements were in the following: completion of an organizational policy, the minimum discharge criteria, patient has met minimum discharge criteria before being discharged (all from 0% to 100% compliance), and giving verbal and written instructions (from 12% to 100% compliance). Criteria 4 (the authority to discharge), 6 (staff training and education) and 7 (being accompanied by family) achieved the least improvement in compliance rates, as baseline measures already showed a high degree of compliance. The compliance rate for criterion 8 (medical file) attained 88%.@*Conclusion@#This protocol utilized a clinical audit process leading to improvements in practice behavior related to patient discharge following endoscopic sedation procedures. A continuous cycle of audit and re-audit will be required in the future to maintain high quality standards.

A prediction model for hypoxemia during routine sedation for gastrointestinal endoscopy

OBJECTIVES: The current study was designed to assess the clinical predictors of hypoxemia and to develop a multivariable, predictive model for hypoxemia during routine gastrointestinal endoscopy. METHODS: In total, 308 patients were enrolled in the analysis. Demographic data, concurrent chronic disease information, anesthetic dose and Modified Observer's Assessment of Alertness/Sedation (MOAA/S) scores were collected and analyzed statistically. RESULTS: Multivariate logistic regression indicated that age (OR: 1.04; 95%CI 1.01-1.08), body mass index (BMI) (OR: 1.12; 95%CI: 1.02-1.21) and habitual snoring (OR: 3.71; 95%CI: 1.62-8.48) were independently associated with hypoxemia. A logistic regression function (LR model) was developed to predict hypoxemia considering the parameters of -7.73+0.04 age (years), +0.11 BMI, and +1.31 habitual snoring (yes or no). The area under the receiver operating characteristic (ROC) curve for the LR model was 0.76. CONCLUSIONS: The LR model, consisting of age, BMI and habitual snoring, was a useful predictor of hypoxemia during routine sedation for gastrointestinal endoscopy.

Sedation Regimens for Gastrointestinal Endoscopy

Sedation allows patients to tolerate unpleasant endoscopic procedures by relieving anxiety, discomfort, or pain. It also reduces a patient's risk of physical injury during endoscopic procedures, while providing the endoscopist with an adequate setting for a detailed examination. Sedation is therefore considered by many endoscopists to be an essential component of gastrointestinal endoscopy. Endoscopic sedation by nonanesthesiologists is a worldwide practice and has been proven effective and safe. Moderate sedation/analgesia is generally accepted as an appropriate target for sedation by nonanesthesiologists. This focused review describes the general principles of endoscopic sedation, the detailed pharmacology of sedatives and analgesics (focused on midazolam, propofol, meperidine, and fentanyl), and the multiple regimens available for use in actual practice.

Endoscopic Sedation: From Training to Performance

Adequate sedation and analgesia are considered essential requirements to relieve patient discomfort and pain and ultimately to improve the outcomes of modern gastrointestinal endoscopic procedures. The willingness of patients to undergo sedation during endoscopy has increased steadily in recent years and standard sedation practices are needed for both patient safety and successful procedural outcomes. Therefore, regular training and education of healthcare providers is warranted. However, training curricula and guidelines for endoscopic sedation may have conflicts according to varying legal frameworks and/or social security systems of each country, and well-recognized endoscopic sedation training systems are not currently available in all endoscopy units. Although European and American curricula for endoscopic sedation have been extensively developed, general curricula and guidelines for each country and institution are also needed. In this review, an overview of recent curricula and guidelines for training and basic performance of endoscopic sedation is presented based on the current literature.

Pediatric Endoscopic Sedation in Korea: A Survey of the Korean Society of Pediatric Gastroenterology, Hepatology and Nutrition / 대한소아소화기영양학회지

PURPOSE: The aim of this survey was to analyze the choice of sedative drugs and their side effects during pediatric endoscopic sedation in Korea. We also evaluated doctors, caretakers and patient satisfaction with the procedures. METHODS: Between June 2006 and July 2006, a 16-item survey regarding current sedation practices, during one month, was mailed to 28 hospitals in Korea. The results of the survey responses were then analyzed. RESULTS: Endoscopy performed under conscious sedation was reported in 89.0% of the responders and endoscopy under general anesthesia in 0.9% of 465 endoscopic procedures. Endoscopy under conscious sedation was performed in 89.1% for upper gastrointestinal endoscopy (GFS) and 88.1% for lower GFS. Midazolam was used for conscious sedation during the endoscopy in 84.5% of cases and propofol was used in two cases (0.5%). In addition, a bezodiazepine/opioid combination was used iin 84.6% (44 cases) for lower GFS. Patients were monitored with pulse oxymetry, EKG (91.4%) as well as automatic BP (5.1%). Transient hypoxia was the only side effect noted and was treated with supplemental oxygen (4.6%). Flumazenil was used in 2.71% of cases. The choice of sedation was made by the endoscopist (84%). The satisfaction rate for endoscopists was 68%, and for the patients and caretakers was 84% (as reported by the endoscopists). CONCLUSION: Midazolam was used only for the upper GFS and benzodiazepine/opioid combination was used for the lower GFS in Korea. The rate of satisfaction was relatively high and there were no significant side effects noted during the endoscopy under conscious sedation.