To the Editor

It is probably the exception rather than the rule, worldwide, for anesthesia personnel to be present during upper or lower GI endoscopy conducted outside of the operating room. However, patients are usually given a sedative and an analgesic, although the need for this combination of medications for upper GI examinations has been questioned.

Several factors apparently have led to the absence of anesthesia personnel during GI endoscopy. These include: 1) the additional cost to the patient, 2) no perception of need by endoscopists, 3) lack of interest by anesthesiologists, and (4) relatively low risk established by millions of procedures done to date.

Despite the established low risk, published articles have shown that 4f6-threatening events can occur during GI endoscopy, and a number of deaths attributed to the sedative and/or analgesic given to the patient have been reported.

One thing evident from practice is the apparent consensus that many, if not most, diagnostic and therapeutic endoscopies do not need to be done in the operating room and/or with anesthesia personnel in attendance. The role of the anesthesiology department when endoscopies are done in a hospital GI lab should be integrated into quality assurance objectives:

* To assure that appropriate analgesics and sedatives are used in appropriate doses;

* To assure that monitoring is consistent with generally accepted standards;

* To assure that personnel are familiar with the pharmacology of the analgesics and sedatives they are administering;

* To assure that the personnel are trained to deal with emergencies related to analgesic and sedative use and that emergency drugs and equipment are readily available;

* To provide consultation upon request;

* To assist with the introduction of a new sedative, analgesic, or monitoring device.

If the condition of the patient is such that endoscopy must be done in the operating room with a surgeon in attendance, the anesthesiologist should do a pre-anesthetic evaluation and provide monitored anesthesia care.

The specialty of anesthesiology currently may have very limited obligation regarding conscious sedation performed outside of the hospital setting for GI endoscopy. If so, the most significant obligation is an educational one assuring that current information regarding patient monitoring and the pharmacology of new drugs reaches the appropriate audience.

Sita Chokhavatia, M.D Assistant Professor Internal Medicine, Gastroenterology

Y. James Kao, Ph.D., M.D Assistant Professor Anesthesiology

James E. Heavner, D.V.M., Ph.D Professor, Anesthesiology and Physiology Director, Anesthesia Research

Texas Tech University Health Sciences Center Lubbock, TX

Editor’s Note: So-called “conscious sedation’ administered by non-anesthesia personnel occurs in many other types of procedures as well as GI endoscopy. Readers are invited to share their experience and opinions on the role of anesthesia providers in non-OR sedation administration.