Is sedation for endoscopy as safe as you think?

1118 Minerva Anestesiologica N November 2017 I n this issue of Minerva Anestesiologica, Brumby et al.8 report an observational pilot study assessing the incidence of failure to recover at day 1 and in subsequent days and weeks after either colonoscopy, gastroscopy, or both procedures combined in 102 patients of over the age of 18 years. Recovery was evaluated not only using physiologic endpoints but also evaluating other aspects such as nociception, emotion, activities of daily living (ADL), and cognition on the following day as well as over a 1-month follow-up period using the multidimensional Postoperative Quality of Recovery Scale (PostopQRS ). All the patients received total intravenous anesthesia with propofol alone or in combination with opioids. Some participants received midazolam or opioids in the pre-operative period. The authors have seen that incomplete recovery is common after colonoscopy, gastroscopy or both procedures. Failure to recover was mainly due to failure in nociceptive and cognitive recovery at day 1 with modest but clinically important differences in early quality of recovery between the procedures. C orrectly, the authors underline that recovery after endoscopic procedures should be defined by a multidimensional tool able to assess emotive, functional and cognitive domains. T his is particularly important because the patients must be discharged as soon as possible and should return to preoperative levels of independency in activities of daily living. Anesthesia demand for colonoscopy and gastroscopy is increasing each year and this is due to need of diagnostic or screening programs and therapeutic management of acute pathologies or neoplastic diseases. Because of the air or CO 2 insufflation for adequate distention and visualization of the gastrointestinal lumen, the endoscopic procedures are associated with significant pain and discomfort, therefore sedation is often required to improve patient tolerance and safety.1, 2 Propofol alone or combined with midazolam and opioids is commonly used for sedation although drugs as etomidate and dexmedetomidine have been introduced.3, 4 Usually, the procedures are ambulatory and the patients must be discharged soon after the endoscopy. Adverse events during sedation for endoscopy are very low and anesthetic techniques are performed to provide sedation minimizing hemodynamic changes and allowing faster emergence and patient’s discharge. Patients can return to their daily lives safely and promptly as soon as have recovered to pre-procedural baseline physical performance.5 However, optimal recovery after sedation for endoscopy is not always observed. C ommonly, a patient’s discharge is related to recovery time, adverse events and physiological parameters such as level of consciousness and stability of vital signs.6, 7 EDITORIAL I s sedation for endoscopy as safe as you think? Germano DE COS MO 1 *, Elisabetta CONGEDO 2 1Department of Anesthesia and Intensive Care, Sacro Cuore Catholic University, Rome, Italy; 2Department of Anesthesia and Intensive Care, Antonio Perrino Hospital, Brindisi, Italy *Corresponding author: Germano De Cosmo, Department of Anesthesia and Intensive Care, Sacro Cuore Catholic University, via G. Moscati 31, 00168 Rome, Italy. E-mail: [email protected] C omment on p. 1161. Minerva Anestesiologica 2017 November;83(11):1118-20 DOI : 10.23736/S0375-9393.17.12260-1 © 2017 EDIZIONI MINERVA INERVAINERVA MEDICA O nline version at http://www.minervamedica.it COPYRIGHT© 2017 EDIZIONI MINERVA MEDICA This document is protected by international copyright laws. No additional reproduction is authorized. It is permitted for personal use to download and save only one file and print only one copy of this Article. It is not permitted to make additional copies (either sporadically or systematically, either printed or electronic) of the Article for any purpose. It is not permitte