Sedation Techniques in Gastrointestinal Endoscopy

Gastrointestinal endoscopy commonly employs procedural sedation to ensure patient comfort, facilitate scope insertion and reduce anxiety, while maintaining rapid recovery and minimising cardiopulmonary risks. Traditional regimens have centred on midazolam, opioids and propofol, leveraging their synergistic effects to achieve moderate or deep sedation. However, variability in haemodynamic stability, respiratory depression and recovery times has driven the search for alternative agents. Recent advances include ultrashort-acting benzodiazepines, novel phenolic derivatives and adjunctive NMDA antagonists. These innovations aim to balance onset and offset kinetics, diminish adverse events such as hypotension or injection pain and accommodate the growing demand for high-throughput endoscopy services. The global imperative remains to personalise sedative choices according to patient age, comorbidity and procedural complexity, thereby enhancing safety and efficiency in routine practice.

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Sedation Techniques in Gastrointestinal Endoscopy publication trend

The graph below shows the total number of articles in sedation techniques in gastrointestinal endoscopy across all publications each year (not limited to Nature Index journals).

Technical terms

Propofol: a rapid-onset intravenous sedative-hypnotic widely used for induction and maintenance of sedation, known for quick recovery but potential cardiovascular and respiratory depression.

Benzodiazepine: a class of sedative agents acting on GABA_A receptors to produce anxiolysis, amnesia and sedation, with variable onset and duration.

Remimazolam: an ultrashort-acting benzodiazepine broken down by tissue esterases, offering rapid offset and lower risk of accumulation.

Ciprofol: a novel 2,6-disubstituted phenol derivative analogous to propofol, exhibiting increased potency and a favourable safety profile.

Esketamine: the S-enantiomer of ketamine that acts as an NMDA receptor antagonist, providing sedative and analgesic effects with reduced psychotomimetic side effects.

References

1. Sedation practices for routine gastrointestinal endoscopy: a systematic review of recommendations. BMC Gastroenterology (2021).
2. Efficacy and safety of ciprofol for the sedation/anesthesia in patients undergoing colonoscopy: Phase IIa and IIb multi-center clinical trials. European Journal of Pharmaceutical Sciences (2021).
3. Remimazolam tosilate compared with propofol for gastrointestinal endoscopy in elderly patients: a prospective, randomized and controlled study. BMC Anesthesiology (2022).
4. Efficacy and safety of subanesthetic doses of esketamine combined with propofol in painless gastrointestinal endoscopy: a prospective, double-blind, randomized controlled trial. BMC Gastroenterology (2022).