Preparing for an upper endoscopy can be nerve-wracking. Thankfully, this routine procedure employs sedatives to maximize patient comfort. Medical professionals often use benzodiazepines and an opioid to put the patient in a state of moderate sedation. An additional dose of hypnotic-like drugs may be administered when needed.
All in all, is upper endoscopy sedation safe? Yes. Sedation is a common part of any medical procedure. It is safer than anesthesia because patients remain awake during the procedure, and often don’t require respiratory support, which decreases the risk of complications.
The Science Behind Sedation
What Does a Sedative Do?
A sedative is a type of drug that targets the brain and nervous system to reduce or eliminate discomfort and fear, as well as promote patient compliance. In minimally-invasive procedures such as an upper endoscopy, a sedative is administered to patients for pain relief and anxiety control. Doctors may elect to increase the dosage for especially uncooperative patients.
Choice of Sedatives
There are two kinds of sedatives administered during an upper endoscopy. Usually both forms of sedatives are administered to maximize patient comfort:
- Throat Spray: Doctors rarely proceed with an upper endoscopy if the patient has chosen to be unsedated. If in any circumstance the patient is unable to take sedatives, a throat spray is usually administered to manage discomfort. The throat spray numbs the throat area so the patient doesn’t have to feel the endoscope as it enters through the mouth.
- Intravenous Sedation: IV sedation or monitored anesthesia is routinely used for upper endoscopies and colonoscopies. Instead of putting the patient into a deep state of unconsciousness, IV sedation allows patients to experience an anxiety-free and pain-free upper endoscopy, without having to rely on machines for breathing support.
With IV sedation, the patient remains conscious but unaware of the procedure. This grants doctors complete patient compliance, and makes patients more open to the possibility of another upper endoscopy in the future.
Three Levels of Sedation
- Minimal: Under minimal sedation, the patient is able to respond to verbal instructions. Patient is also somewhat aware of the procedure due to the low dosage of sedation.
- Moderate: Under moderate sedation, a combination of a benzodiazepine and an opiate are often combined. Under moderate sedation, purposeful verbal and tactile stimuli are required to get a response from the patient.
- Deep: Under deep sedation, the patient is still conscious but is unaware of the procedure. A powerful sedation such as a large dose of hypnotic and opiate are often combined to put a patient in this state. Under deep sedation, patients only respond to extremely painful stimuli.
Patients undergoing an upper endoscopy can be put under a minimal or moderate state of sedation, depending on the pre-sedation assessment conducted by the gastroenterologist. It’s possible for doctors to raise the level of sedation if needed in order to guarantee a successful examination.
What’s In It?
In order to create a relaxing environment for the patient, doctors often use two or more types of sedatives to achieve the ideal level of sedation. Below are the following drugs used in order to create this effect:
Benzodiazepines are drugs that cause sedation. An additional drug such as opiod is often required for an upper endoscopy since benzodiazepines don’t have anesthetic qualities. They don’t help with pain and exclusively produce sedation when ingested.
There are different kinds of benzodiazepines used for medical procedures. Diazepam is often used in daytime surgeries. However, patients under diazepam take a long time to recover, which is why doctors recommend a newer sedative called midazolam.
Unlike diazepam, midazolam breaks down faster, meaning patients don’t have to wait more than 24 hours before resuming normal activities. A different type of benzodiazepine might be recommended for pregnant women.
Opioids are drugs designed for pain relief. Opiods work by attaching on receptors responsible for sending pain messages to the brain. Blocking the communication between the brain and receptors lead to a reduced feeling of pain.
Various opioids are available for medical use. Morphine and oxycodone are often administered to patients who are suffering from chronic pain or who have just undergone major surgery. For a minimally invasive procedure like upper endoscopy, fentanyl is the common opioid used by doctors.
Like benzodiazepines, some opioids may not be ideal to use for pregnant women. It’s important to let your doctor know if you are expecting in order to find alternatives to fentanyl and similar types of opioids.
Drugs with hypnotic properties can be used to put a patient into deeper sedation. One of the most commonly used hypnotics in an upper endoscopy is propofol. Propofol produces an anesthetic-like effect in that the patient reaches sedation similar to unconsciousness. However, during a state of deep sedation induced by propofol, more monitoring is required in order to prevent respiratory complications.
As such, gastroenterologists have to employ certain techniques to prevent any complications during propofol sedation. Propofol is only administered if the gastroenterologist is ready to insert the endoscope. Propofol doses are often carefully mixed with a fast-acting opioid in order to suppress respiratory problems in the patient.
How Long Do Sedatives Last?
After the procedure, patients are usually asked to stay 1 to 2 hours in the hospital or clinic as the sedative wears off. Even after the patient recovers from the procedure, an escort is still necessary to take the patient home, since grogginess is still strong within 24 hours after the procedure.
Expect the following side-effects of sedatives:
- Having trouble focusing
- Poor reflexes
- Speaking more slowly
- Impaired vision and perception
In general, we advise individuals to stay at home for 24 hours to fully recover from an upper endoscopy. It is not advisable to take on activities such as driving or any other activity immediately after the procedure.
Why Use a Sedative?
An upper endoscopy is a screening and diagnostic procedure that is performed by inserting a long, thin, flexible tube through the mouth to study the esophagus, stomach, and duodenum. While the exam only takes 15 to 30 minutes, an upper endoscopy isn’t exactly the most relaxing medical procedure.
You can read more about upper endoscopy in our post: A Complete Overview of Upper GI Endoscopy.
Doctors sometimes inflate the stomach or intestine for better visualization. To some patients, the extra air in their digestive tract can be uncomfortable. Sedation is routinely administered by gastroenterologists to maximize patient comfort.
Upper endoscopy uses what is known as “conscious sedation”. During the procedure, patients are sedated, but remain awake during the exam. Sedatives help control anxiety and discomfort, which allows patients to relax during the procedure.
Sedatives often have an amnestic component, which means that patients are put in a state of short-term memory loss. The amnestic characteristic of sedatives means patients will not recall the examination, improving their overall experience. This is crucial in ensuring future endoscopy recommendations are well-received and that patients who have undergone endoscopic procedures in the past don’t discourage other patients from undergoing the procedure.
It’s possible for patients to undergo an upper endoscopy without sedation. Different clinics have certain rules regarding sedation. Be sure to check with your doctor for options to undergo a non-sedated exam.
Possible Risks and Complications
According to a study published in World Journal of Gastrointestinal Endoscopy, the risk of sedation-related problems during an endoscopy are incredibly low. The risk only increases under the following circumstances:
- If the patient is 60 years old and above
- If the patient is already medically compromised
- If the patient has cardiovascular and respiratory ailments
- If the procedure involves an inexperienced trainee or medical professional
The possible complications associated with an upper endoscopy are:
- Hypotension or the rapid decline in blood pressure
- Hypertension or the rapid increase of blood pressure
- Irregular heart rates due to anxiety
- Airway obstruction
- Allergic reaction to anesthesia or sedative
- Vomiting and nausea
Special Cases for Sedatives
Special medical cases require further consideration when it comes to taking sedatives. These include:
Medical History: Before administering a sedative, patients are required to undergo a pre-sedation evaluation so doctors can understand whether patients will be receptive of the sedatives or not. Normal healthy patients are characterized as those who have no history of long-term alcohol and cigarette use, as well as not have a history of diseases.
Patients with mild systemic diseases, for example hypertension, are still allowed to under sedation, provided that they don’t have a medical history of withdrawal from sedatives. On the other hand, patients with severe to life-threatening diseases such as coronary artery disease often undergo various tests to prevent any complications during the upper endoscopy.
Allergies: The pre-sedation assessment also includes an understanding of the patient’s allergic history. Although rare, allergic reactions can occur during sedation. Reactions range from mild to more severe. If the patient experiences respiratory problems, antihistamines and airway management is applied to manage the situation.
Patients with known allergies to sedatives used during an upper endoscopy may opt to undergo the procedure unsedated. In this case, a throat spray will be used to numb the throat. However, the patient will be fully aware of the procedure.
Pregnancy and Lactation: Pregnant and lactating women can still undergo sedation during an upper endoscopy. However, certain adjustments are recommended as outlined by the guidelines provided by the American Society for Gastrointestinal Endoscopy (ASGE).
For instance, the commonly used drug diazepam should not be used for pregnant women due to a link in fetal deformation. Midazolam is often used as an alternative, provided that the patient is not in the first trimester.
Treatment is more rigorous for expectant individuals. Pregnant patients have narrower airways and are more susceptible to cardiopulmonary complications. As such, monitoring is made mandatory for sedated pregnant patients.
After Endoscopy: What to Avoid
Patients can still experience dizziness, grogginess, confusion, short-term amnesia, and poor reflex hours after an endoscopy. We recommend staying away from the following activities on the day of the exam:
- Cooking because of the risk of burns and accidents involving fire
- Making major financial decisions
- Being in charge of children and the elderly
- Taking additional sedative medication not prescribed by doctors
- Drinking alcohol
- Driving any sort of vehicle
- Using heavy machinery
- Participating in activities such as sports that require skill and judgment
What if I am not allowed to take the sedative?
Patients who aren’t allowed to take a specific sedative are usually administered with a safer variation of the drug. If in any case medical professionals strongly recommend going unsedated, a throat spray will be used to numb your throat and minimize your discomfort during the endoscopy.
How will I feel after being sedated?
Immediate side-effects of sedation include grogginess, poor reflexes, confusion, minor depressive symptoms, amnesia, difficulty focusing and making decisions, and sleepiness. We suggest resting the entire day of your endoscopy, and continuing bed rest if side-effects persist the next day.
Why Do I Need an Escort After My Endoscopy?
Sedatives can affect a patient’s reflexes and alertness. As such, it is advised for patients to find an escort to take them home after an endoscopy. Driving a vehicle while under the influence of sedatives can lead to an accident. We recommend asking a relative or friend to drive you home on the day of your procedure.
Is sedation for endoscopy safe?
Yes. Sedation is routinely performed during upper endoscopy. A pre-sedation assessment is also performed to ensure patient safety.
How much do sedatives cost?
IV sedation often costs between $200 – $900 depending on the drug used and dosage. You can ask your gastroenterologist beforehand for the cost of the sedative before the procedure.
Book an Upper Endoscopy Today
At Gastro Center in New Jersey, we understand the qualms patients have regarding an upper endoscopy. But with proactive medical practices and compassionate customer service, we are dedicated to giving you a pain-free and anxiety-free session.
We recommend undergoing the exam sedated for best results, but patients can also opt to go unsedated if needed.
Get in touch with us today to learn more about sedative options for upper endoscopy.