Changing patterns of sedation use for routine out-patient diagnostic gastroscopy between 1989 and 1998

Background: Knowledge of sedation trends for upper gastrointestinal endosco py is important for health service planning, particularly in view of rapidl y increasing demands on endoscopy services. However, no data are available on sedation trends in Britain over the past 10 years. Aim: To determine sedation use for routine gastroscopy in a single endoscop y unit between 1989 and 1998. Methods: This was a retrospective study of 9795 consecutive adults (mean ag e 56 years, range 18-100 years; 4512 females) who had undergone a gastrosco py between 1989 and 1998. Clinical, pharmacological and endoscopic data wer e retrieved from a computerized database. Results: Over the 10-year study period, the sedation rate remained constant for patients undergoing therapeutic endoscopy (P=0.99) and those undergoin g in-patient diagnostic examinations (P=0.63). In contrast, the sedation ra te for out-patient diagnostic endoscopy decreased by 54%, from a high of 70 % in 1990 to 32% in 1998 (P < 0.0001). Logistic regression analysis showed that the decline in sedation use was greater in females (P < 0.0001) than m ales and in procedures performed by non-consultant compared to consultant s taff (P=0.01). Conclusions: If our results form part of a national trend, they will have i mportant implications for cardiopulmonary monitoring strategies, recovery r oom practices and for complication rates due to the use of sedation for upp er gastrointestinal endoscopy.