Endoscopy in deep sedation

What you need to know before the examination?

Deep sedation is a procedure that is routinely conducted under supervision of an experienced anaesthetist. The endoscopic examination, which can otherwise be uncomfortable, will be simply slept through and you will not feel any pain. Just before the procedure, you will receive intravenous medication to calm you down and put you to sleep. The procedure is safe, the amount of medication is significantly less than with general anaesthesia for surgery, and there are fewer side effects. 

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. The use of the anaesthetic propofol is prohibited in those with an allergy to eggs and/or soya. 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 deep sedation procedure. If you are over 55 years old, you need fresh results of ECG, laboratory haemogram and electrolytes (Na, K, Cl). 

If the estimated risk associated with sedation is too big in your case (in rare cases of unstable comorbidities), 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. 

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. 

 During the examination, the anaesthesiologist and the additional sedation nurse continuously monitor the condition, adding medication as needed – with gradual additions, we achieve optimal sedation and reduce the chance of complications. 

You rest in the recovery room after the test, 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 an anaesthetist 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?

Endoscopic examinations (colonoscopy, esogastro-gastro-duodenoscopy) can be performed with no additional medication, with only a local anaesthetic for the throat during gastroscopy and a local ointment for the buttocks during colonoscopy. Patients may feel uncomfortable during examinations, but pain can be alleviated by working together. For those who do not want to suffer any discomfort or potential pain, or in those where the previous endoscopy was interrupted due to intolerance, we opt for sedation. We use medications which are used for anesthesia during surgery procedures, with the difference that the dose in case of deep sedation is significantly smaller. Just before the procedure you will be injected (intravenously) with the medication, which will put you to sleep for a few minutes. We use propofol, which has a short-lasting sedative (anaesthetic) effect, in combination with a sedative (midazolam) and a painkiller. 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, they are added every few minutes as needed during the procedure, and you wake up very soon after 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). 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.