Endoscopic procedure under analgosedation

What you need to know before examination?

Analgosedation is a procedure that is routinely conducted under supervision of an experienced gastroenterologist and medical staff. Before the endoscopic examination, which can otherwise be uncomfortable, you will receive medication in a vein. Thus, we achieve a feeling of calm, relaxation, and reduced pain as much as possible. You may stay awake or fall sleep for a short period of time during the examination, and you may not remember everything. The procedure is safe and has been routinely performed at the Medical Center Rogaška for more than 15 years – there have been no serious complications so far. 

Before sedation, you will complete a questionnaire to assess your risk in advance. 

We need detailed information on the medications you are taking regularly or occasionally, possible known allergies to medications, food, and other allergies. You must not drink any alcohol 24 hours prior to the sedation; you have to also inform us if you take any tranquillizers, psychoactive substances, and drugs. We need your written consent for the analgosedation procedure. If you are over 55 years old, you need fresh results of ECG, laboratory haemogram and electrolytes (Na, K, Cl). 

Individuals with comorbidities with frequent deteriorations taking a lot of medication or are elderly may be at increased risk of complications. In these cases, deep sedation is advised under the supervision of an additional doctor, an experienced anaesthetist. 

If the estimated risk associated with sedation is too big in your case (in rare cases), sedation in an outpatient setting may be refused, as in high-risk situations, sedation is only possible in a hospital setting under the supervision of an anesthetist, and the possibility of intensive therapy in the immediate vicinity. 

HOW IS SEDATION PERFORMED? 

The whole process has three stages. The preparation, wake-up time and observation time add about 1 hour to the endoscopy procedure. 

PREPARATION: We take vital signs measurements upon arrival and set up an intravenous line in an arm vein to administer medication. Talk to your doctor about your general health, chronic illnesses, any hospitalisations, surgeries and previous anaesthetics, allergies, bad habits and other risks. You can ask your doctor if you need further clarification or explanation. 

Sedated examination: Just before the endoscopy starts, a registered nurse will administer sedatives and painkillers. During sedation, we continuously monitor the condition, adding medication as needed – with gradual additions, we achieve optimal sedation and reduce the chance of complications. 

After the examination: You rest in the recovery room after the examination, under the supervision of medical staff, and periodic blood pressure, pulse and saturation measurements are taken. Occasionally, an intravenous infusion is needed. You are examined again by the doctor before discharge. You will receive post-sedation instructions, including in writing. After sedation, you should NOT drive a car, operate machinery or do other tasks that require psychomotor effort. 

What is sedation during endoscopy and what medications do we use?

For those who do not want to endure any discomfort and potential pain during endoscopic examinations, or who have bad experience with previous endoscopies, analgosedation can be used. Just before the procedure you will be injected (intravenously) with the medication. We use a combination of a sedative (midazolam) and a strong painkiller (fentanyl). All of these medications have an immediate effect and a short half-life (the effect wears off quickly). 

As medications have possible adverse effects, you will be under the supervision of experienced staff all the time, who will monitor your condition, and carry out periodic measurements of blood pressure, heart rate and oxygen in the blood. Not all people react in the same way to a certain medication. The dosage is graduated according to weight, age, comorbidities and the use of other medicines. Their effect is rapid after injection into the vein, and they are added as needed during the procedure. The procedure has no consequences; for some time the reflexes, thinking and judgment are slow. 

Possible side effects

Very rare side effects include oversedation, a drop in blood pressure, heart rate and impaired breathing – then we have to act according to the patient’s condition (maintenance of respiration, artificial respiration if required, medications and infusions to raise the blood pressure and heart rate). We have medications that counteract the effects of the medications used by reducing or nullifying their (excessive) effects. An inflammation may occur at the site of the injection or administration of medication – usually, a cold compress is enough for mitigation. On very rare occasions, an allergic reaction may occur – you must inform us if you are allergic to anything! 

After sedation

After the examination, you will be under supervision in the recovery room as long as necessary (expectedly half an hour to one hour). The medications used will have certain effects, due to which you will have some restrictions after the examination. Upon your discharge, somebody will have to escort you home and stay with you for another couple of hours if possible. You will be given instructions. After the procedure, you must not drive, operate machinery, or make any important decisions for another 6–24-hour period. You are not allowed to drink alcohol for 24 hours after the examination. It is recommended to take time to rest on the day of the examination; you will be fit for work the next day. The exact duration of the restriction depends on the medication that was used.