Sedation in Endoscopic Practice

Today's endoscopist must make important practice-management decisions regarding sedation. The options range from unsedated endoscopy to deep sedation given by an anesthesia specialist. Although unsedated endoscopy enhances operational efficiency, it has not been widely embraced in the United States. Data indicate that propofol represents an improvement over benzodiazepine/narcotic-based sedation. Newer medications and new endoscopic, monitoring, and drug-delivery technologies will continue to change sedation practices. If the use of anesthesia services in endoscopy continues to grow, there is a significant risk that payors will disallow them or will decrease professional fees to endoscopists who involve anesthesia providers. Despite unfavorable regulatory and economic incentives, non-anesthesiologist propofol administration has accumulated a large experience and an excellent safety record. Ideally, both anesthesiologist-based and non-anesthesiologist-based solutions will be developed cooperatively by the anesthesiology and gastroenterology communities and will become available to endoscopists. This outcome will best accommodate differences in professional style, practice characteristics, and local culture. For this outcome to occur, economic incentives for physicians must align with risk, work, and costs.