Anesthesia-Mediated Sedation for Advanced Endoscopic Procedures and Cardiopulmonary Complications: Of Mountains and Molehills

Anesthesiologist-administered sedation for gastrointestinal endoscopy has become an indelible and somewhat controversial part of our practice landscape. I am not here to expound upon the pharmacoeconomic and regulatory maelstrom that propofol-mediated sedation has created or tout the fact that the safety record for endoscopist-directed propofol is impressive.¹ Instead, I would invite the reader to step into the world where anesthesiologist-assisted sedation may play an important role: procedures such as endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasonography (EUS) where deep sedation or general anesthesia for extended periods is the rule. Even this indication for anesthesiologist-administered sedation is controversial. Numerous studies have shown that gastroenterologist-directed propofol sedation for ERCP and EUS results in improvements in throughput, recovery, and patient satisfaction. The cumulative numbers, however, are not robust enough to render a final opinion on safety as they are for upper endoscopy and colonoscopy. Surprisingly, the same can be said for monitored anesthesia care for endoscopy.