Premedication, preparation, and surveillance

Once again the staggering variation in IV sedation practice between differe nt countries is highlighted. This year the "to sedate or not sedate" debate focuses on colonoscopy Several papers on the use of Propofol are reviewed, It remains this authors' opinion that propofol is an anaesthetic agent to be used by (or at least in the presence of an anaesthetist. Informed consen t and the question of what to do if a patient withdraws consent halfway thr ough the procedure are discussed. Predictably further recent papers on the relative merits of midazolam and diazepam ale presented plus another report on the use of flumazenil in the recovery period. The use of 3% hydrogen pe roxide solution to aid the visualization of acutely bleeding gastro-duodena l lesions is presented in two papers along with a discussion of its possibl e mode of action. The use of antispasmodics to aid colonoscopy is further d iscussed: this year concentrating on the use of hyoscyamine sulphate las op posed to hyoscine butylbromide, the preferred agent in the UK). The patient s receiving hyoscyamine sulphate had significantly shorter caecal intubatio n times, better sedation and easier colonic insertion. The "downside" was d rug-induced tachycardia and the authors caution against the widespread use of this drug until this situation is further clarified. The subject of hypo xaemia at the time of gastroscopy; colonoscopy and ERCP was reviewed last y ear and further papers are presented in which the incidence of various leve ls of hypoxia are given, In anaesthetic circles it would be considered tota lly unacceptable to allow a patient's oxygen saturation to fall below 85%, and Set we continue to have papers reporting its incidence. This level of d esaturation is potential dangerous and the routine use of supplemental oxyg en would greatly reduce this unneccessary risk to patients.