SEDATION
Numerous controlled studies have shown comfort and satisfaction when using IV sedation during endoscopic procedures. The choice of operator-dependent sedation, but benzodiazepines are generally used alone or in combination with an opioid.
BENZODIAZEPINES
Are the most used, induce relaxation, cooperation, and occasionally produce transient amnesia. The dose varies according to age, weight, comorbid conditions, use of other drugs and the level of complexity of the procedure. Can cause respiratory depression. We recommend the use of midazolam IV at doses of 0.1 to 0.5 mg/kg. Recommendation Grade A.
OPIATE
Provide analgesia and sedation. Tolerance can be affected by patient factors. Used alone or combined with other sedatives. The dose should be administered slowly, in small quantities and for an appropriate time. It can cause respiratory depression. The most commonly used doses of meperidine to 1 to 2 mg / kg / IV. Recommendation grade B.
Specific antagonist of benzodiazepines and opiates
The benzodiazepine antagonist flumazenil and naloxone, opioid antagonist, are available and should be in every endoscopy unit. The effect is not instantaneous and often very short in relation to sedative medication used for what is necessary to repeat the dose several times. It is not advisable to rely solely on these antidotes to compensate for oversedation and the risk of injury and hypoventilation may be higher.The dose of flumazenil is 0.2 mg IV, repeated in equal doses every minute up to 1 mg total dose. Recommendation grade B.
MONITORING postprocedural
Following completion of the procedure, the patient should be observed for adverse effects instrumentation or sedation. Postprocedural follow-up time on the risk set.
The patient is taken to a recovery room and stay there until vital signs are stable and the patient recovers its initial level of consciousness.
The patient should be instructed before the administration of sedatives that may occur over a period of altered consciousness, and the trial. Should be told not to drive, operate machinery or make decisions that can have legal implications. Whenever a patient is sedated should be accompanied by a responsible family who will be responsible for driving to his home.
The patient should receive written instructions on the symptoms and signs of possible adverse reactions that may arise and the steps to follow if they are presented, including a telephone number that operates 24 hours a day and the nearest hospital.
credit to: Fernando Garcia del Risco
Source: www.encolombia.com/gastro14299_sedacion.htm
image source: www.bcn-sc.com/wmContent/wmWebadmin/procedures/Lumbar/Lumbar%20Endoscopy.jpg
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