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Endoscopic sedation and monitoring practice in Germany: results from the first nationwide survey.

Research paper by A A Riphaus, M M Rabofski, T T Wehrmann

Indexed on: 09 Feb '10Published on: 09 Feb '10Published in: Zeitschrift fur Gastroenterologie



Abstract

The use of sedation (e. g., of short-acting propofol) for gastrointestinal endoscopy has shown an upward trend in the United States and Europe over the last decade. This survey aimed at providing nationwide data on the current practice of endoscopic sedation and monitoring in Germany.A 21-item survey regarding current practices of endoscopy, sedation and monitoring in gastrointestinal endoscopy was sent to 3 802 members of the German Society of Digestive and Metabolic Diseases (DGVS).A total of 1 061 / 3 802 (28%) questionnaires were returned. The respondents performed an average of 28 esophagogastro-duodenoscopies (EGDs) and 25 colonoscopies per week. Endoscopic procedures were staged in a hospital setting (60%) more often than in private practices (40%). The majority of the EGDs (74%) and colonoscopies (87%) were carried out under sedation, however, this fact may be influenced by a recall bias. The most frequently used agents for sedation were midazolam in 82% and propofol in 74% of the cases. The most common sedation regimens applied were propofol plus benzodiazepines (38%) and benzodiazepines with an opioid (35%). Patients were routinely monitored by pulse oximetry (97%), automated blood pressure readings (29%) and/or electrocardiography (13%). Supplemental oxygen was routinely administered in 34% of them. Endoscopists' satisfaction with sedation was greater among those using propofol than in the group applying benzodiazepines (visual analogue scale, 8.8 +/- 0.9 vs. 8.2 +/- 1.3, p < 0.0001).Besides the common administration of short-acting benzodiazepines, sedation with propofol is also gaining ground in Germany; it is applied mainly in low doses (up to 150 mg). German endoscopists are highly satisfied with these sedation regimens, with propofol significantly leading the score. Patient monitoring predominantly follows currently prevailing guidelines.