Introduction Sedation and analgesia are considered an essential component and are commonly used by endoscopists in endoscopic procedures.¹ The primary goal of a procedure involving sedation is to reduce a patient’s anxiety and discomfort as well as improving their tolerability for the examination. Four stages of sedation have been classified ranging from minimal sedation (anxiolysis), moderate (conscious sedation), deep sedation to general anaesthesia. Deep sedation is defined as a stage where a patient can not be easily aroused but responds purposefully following repeated painful stimulus.²

Traditionally patients who fail conventional sedation for endoscopy have heavier sedation in operating theatres, which requires occupying the emergency theatre and use of valuable theatre resources.

With the dedicated deep sedation endoscopy services we are able to provide such a service as scheduled.

Method Huddersfield Royal Infirmary has been running a deep sedation endoscopy service on every alternate Tuesday since June 2014. The aim is to manage patients who tolerate endoscopic procedures poorly. From their database, 127 patients were included between August 2015 and August 2016. All patients were referred as either fast track, urgent or routine. Deep sedation endoscopy is conducted in the endoscopy department with anaesthetic set up and presence of endoscopist, endoscopy nurse, an operating department practitioner and anaesthetist. Induction agents include Propofol 1% and occasionally Alfentanil without intubation.

Results 127 patients were included from 140 procedures conducted. 77% (108/140) of these were gastroscopy, 17% (24/140) were colonoscopy and 6% (8/140) were sigmoidoscopy. 7 patients were referred as fast track, with a mean of 17 days and median 13 days until procedure. 9 patients were referred as urgent, with a mean of 24 days and median of 21 days until procedure.

Conclusion The introduction of a deep sedation session in the endoscopy department has effectively minimised the resources such as theatre use and staffing involvement. It has also improved the quality of endoscopy secondary to a familiar environment whose use by the endoscopist and anaesthetist are familiar with the procedure involved.

Guidelines for referring a patient for endoscopy under deep sedation should be anticipated to ensure resources are being used appropriately. Further studies are indicated to establish whether this will reduce waiting times for patients who need the service.

References

1. . Cohen LB, Wecsler JS, Gaetano JN, Benson AA, Miller KM, Durkalski V, et al. Endoscopic sedation in the United States: results from a nationwide survey. Am J Gastroenterol2006;101:967–974.

2. . Gross JB, Bailey PL, Connis RT, Cote CJ, Davis FG, Epstein BS, et al. Practice guidelines for sedation and analgesia by non- anesthesiologists. Anesthesiology2002;96:1004–1017.

Disclosure of Interest None Declared