Endoscopic sedation and premedication

Abstract

Endoscopic sedation is intended primarily to reduce a patient?s anxiety and discomfort, consequently improving their tolerability and satisfaction during the procedure. It also gives the endoscopist the chance to obtain the optimal endoscopic investigation, best position of the patient and adequate time to complete the procedure. In contrast to these advantages, sedation adds to the overall cost of an endoscopic procedure, and increases the risk of cardiopulmonary complications. In addition, the use of some sedative agents by practitioners (such as endoscopists or nurses) other than anesthesiologists could lead to legal problems. The word ?sedation? is not used in reference to only one condition; on the contrary, this term is used to define a process containing multiple stages (continuum sedation). There are four stages of sedation. When sedative agents are applied to a patient, four different stages of sedation can be observed based on the type of the agent, its dosage and the patient?s characteristics: anxiolytic effect (the minimum effect), moderate sedation, deep sedation and general anesthesia. Generally, moderate sedation is the goal during endoscopic procedures. When deep sedation or general anesthesia occurs in a patient unexpectedly, cardiopulmonary resuscitation can be vital; otherwise, the condition can become fatal if appropriate intervention can not be done. Consequently, practitioners must possess the skills necessary to resuscitate or rescue a patient whose level of sedation is deeper than planned.

Keywords

• Endoscopy, sedation, education

Endoskopik sedasyon ve premedikasyon

Öz

Endoskopik sedasyon; temelde hastada işlemle ilgili oluşan ve/veya oluşacak olan rahatsızlık hissi ve kaygılı durumu azaltmak ve bunun sonucunda da hastaların işlemi daha kolay tolere edebilmelerini sağlamak amaçlı kullanılır. Ayrıca endoskopiste doğru endoskopik inceleme ve işlem için uygun hasta durumu ve zaman sağlar. Dezavantajlarından bazıları ise endoskopik işlemle ilişkili kardiyopulmoner komplikasyonları ve endoskopik işlemin maliyetini arttırmasıdır. Sedasyon amaçlı kullanılan bazı ilaçların anestezi uzmanı olmayan personelce (endoskopist, yardımcı hemşire) kullanımı da bazı yasal sorunları gündeme getirebilir. Sedasyon kelimesi tek bir durumu ifade etmek için kullanılmaz, belirli aşamaları içeren devamlılığı söz konusudur (continuum sedation). Buna göre sedasyonun 4 evresi vardır. Hastaya sedasyon amaçlı ilaç verildiğinde, verilen ilaca, doza, hastanın özelliklerine ve işlem süresine bağlı olarak en hafif etki (anksiyolitik etki)?den sırasıyla orta dereceli sedasyon, derin sedasyon ve genel anesteziye kadar uzanan klinik tabloyla karşılaşılabilir. Endoskopik işlemlerde hedeflenen evre, genellikle orta derecede sedasyon evresidir. Beklenmedik şekilde derin sedasyon ve genel anestezi durumu gelişen hastaya kardiyo-pulmoner sistem desteği gerekebilir ve uygun müdahale yapılamazsa hastada seyir beklenmedik şekilde ölümcül olabilir. Bu nedenle sedasyon uygulayan kişi, hastanın resüstasyonu ve kurtarılması konusunda gerekli eğitimi almış olmalıdır ve bu tür girişimleri tereddütsüz yapabilmelidir.

Anahtar Kelimeler

• Endoskopi, sedasyon, eğitim

Kaynakça

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