Akira Horiuchi, MD from the Digestive Disease Center at Showa Inan General Hospital in Komagane, Japan discusses his Technical Review article “Special topics in procedural sedation: clinical challenges and psychomotor recovery” from the September issue.
The aim of this review is to provide the reader with an overview of the current knowledge concerning assessing and enhancing psychomotor recovery related to sedated gastrointestinal endoscopy.
Significant economic advantages would accrue if the time of impairment could be shortened or eliminated so that healthy individuals could drive home unaided or return to work soon after their sedated endoscopy. This review discusses the impediments to a policy of routine discharge to normal activity following sedated endoscopy.
Currently, gastrointestinal endoscopy under sedation is well tolerated and accepted by both patients and endoscopists. Although sedation using midazolam and an opioid is widely used, propofol appears similar in safety and superior in terms of psychomotor recovery. Propofol alone also appears to have advantages of allowing driving after sedation, for use in elderly individuals, and as well as in patients with chronic liver disease. The spreading use of doctor or nurse-administered propofol may contribute to the improvement of the acceptability to endoscopy, which may further enable population wide screening and result in a decrease of colorectal cancer deaths.
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