Prevention of Complications of Sedation

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Conscious Sedation - Prevention of Complications

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Dr. Minocha is a practicing gastroenterologist and author of "Natural Stomach Care: Treating and Preventing Digestive Disorders with Best of Eastern and Western Therapies".

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PREVENTION OF COMPLICATIONS OF SEDATION

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Informed consent is a prerequisite to sedation and endoscopy. Appropriate equipment for CPR must be readily available.

Patient evaluation is important to reduce the risk of adverse outcomes. Pre-procedure fasting is recommended although of unproven benefit.

Monitors for pulse, heart rate, breathing are routinely used during endoscopy. There is lack of any evidence proving that they affect overall outcome. Thus the benefit from the monitoring may only accrue to the high risk patients. We should understand that oxygen supplementation corrects drop in oxygenation but does not affect accumulation of carbon-dioxide in blood.

After the procedure, the patients should be watched for any complications. The period of monitoring ranges from 30-120 minutes. We should make sure that vital signs are stable and patient has regained acceptable level of consciousness prior to discharge. Patients should not drive, do heavy machine-work or make legally binding decisions on the day of the procedure. Written instructions should be given at the time of discharge.

Naloxone (Narcan) and Flumazenil (Romazicon) are specific antagonists of opiates and benzodiazepines respectively. These blockers are no substitute for CPR.

CONCLUSION :While sedation is responsible for most procedure related complications of heart and lungs, its benefits are controversial. Most commonly used sedatives include benzodiazepines and opiates. Although opiates cause more problems than the benzodiazepines, the latter are responsible for most serious events and deaths. We should make all efforts to minimize complications including proper patient selection, use of minimal dose necessary for sedatives and proper monitoring of patient during and after procedures.

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