Australian Anaesthetists’ Practice of Sedation for Gastrointestinal Endoscopy in Adult Patients

Abstract

A wide spectrum of practice in sedation for gastrointestinal endoscopy in adult patients is documented overseas, but a current profile of the practice of Australian anaesthetists is unavailable. We therefore surveyed 200 Fellows of the Australian and New Zealand College of Anaesthetists on the choice of drugs and monitoring, use of analgesic throat spray and prophylactic intravenous fluids and the depth of sedation for gastrointestinal endoscopy. Our response rate was 57% and endoscopy formed a significant part of most respondents’ practices. Propofol was used for almost all procedures, in combination with midazolam alone (14%), fentanyl alone (6%), midazolam and fentanyl (61%), another drug (15%) or no adjuvant(4%). The majority of patients received prophylactic intravenous fluids for endoscopic retrograde cholangio-pancreatography (83%) and colonoscopy (64%), but not for gastroscopy (20%). All patients received supplemental oxygen and monitoring with pulse oximetry. However, over 20% of patients having gastroscopy or colonoscopy did not have noninvasive blood pressure monitoring. A maximum depth of sedation during which the patient was unresponsive to painful stimulation (commensurate with general anaesthesia) was targeted by 54% of respondents. Significant variations exist in the practice of sedation and monitoring for endoscopy in adult patients by anaesthetists in Australia.