Physicians should be fully aware that sedation may be associated with a variety of adverse reactions. Particular attention should be given to respiratory depression and cardiovascular depression. The patient's condition is closely monitored during the examination, but the operator tends to concentrate on the endoscopic monitor. Preferably, one physician or endoscopy technician is dedicated solely to monitoring the patient.

The American Society for Gastrointestinal Endoscopy has reported that the combination of three devices—pulse oximeter, automated sphygmomanometer, and electrocardiograph monitor—is most useful and effective for patient management [3]. Simple attachment of the sensor to the finger of the patient allows a pulse oximeter to display blood oxygen saturation and sound an alarm when hypoxia occurs; thus, it appears to be essential during sedation. When the oxygen saturation is 90% or less, the patient should be given verbal commands repeatedly. If the stimuli are insufficient, oxygen inhalation is started. During oxygen administration, however, ventilatory insufficiency may occur in the presence of satisfactory oxygen saturation, and thus supplemental oxygen should be kept at a low level. During double-balloon endoscopy, often performed to investigate the cause of gastrointestinal bleeding or anemia, the use of an electrocardiograph monitor, blood pressure monitor, and pulse oximeter is recommended in all individuals, particularly those who are older and patients with heart disease or chronic respiratory disease.

■ References

1. Sawatake N, Munakata A, Sakai Y (2002) Guidelines for endoscopy in older individuals. In: Guidelines for gastroenterological endoscopy, 2nd edn. Igaku-Shoin, Tokyo, pp 157-163

2. Fujinuma S, Seike M, Ohta A, et al (2003) Use of premedication and patient management in colonoscopy. Endosc Dig 11:1587-1591

3. ASGE (1995) Technology assessment status evaluation: monitoring equipment for endoscopy. Gastrointest Endosc 42:615-617

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