Premedication, preparation, and surveillance

During the last two years, the Hell-known positive role of benzodiazepines (midazolam and diazepam) in conscious sedation, both in adults and pediatri c patients, has been confirmed by several studies. However, problems concer ning the role of sedation and analgesia in nonoperative endoscopy are still a matter of debate. Particular attention has focused on attempts to identify the "ideal candida te" for conscious sedation, and on the importance of providing patients wit h information before the procedure, which should be matched to each patient 's style of coping. Before detailed information about a medical procedure i s gi, en blindly, the clinician should investigate whether such information will benefit or adversely affect the patient receiving it. An important aspect of the sedation procedure is the prevention of hypoxia and cardiopulmonary complications, Recent endoscopic experience has provide d little additional information concerning the well-known risk of oxygen de saturation during conscious sedation. Performing endoscopy in sedated patie nts reduces, but does not eliminate, the risk of hypoxia. Some independent variables capable of predicting severe desaturation have been recognized, s uch as basal SaO(2) < 95 %, respiratory disease, more than one attempt need ed for intubation, emergency procedure, and an American Society of Anesthes iologists score of III or IV. As far as preparation is concerned, some light has been cast by a meta-anal ysis of a available studies concerning the role of sodium phosphate and pol yethylene glycol electrolyte lavage solution (PEG-ELS). The former preparat ion has been found to be as effective and less costly compared with the lat ter: In particular, sodium phosphate may be preferable in patients,without cardiovascular or renal co-morbidity, and in those with a tendency to devel op nausea or bloating.