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Importance of pharmacology to avoid complications with endoscopic sedation
  1. Fernando Martins do Vale1,
  2. Diogo Ferreira Marques2
  1. 1 Instituto de Farmacologia e Neurociências, e IMM, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
  2. 2 Department of General Surgery, Hospital Garcia de Horta, Almada, Portugal
  1. Correspondence to Professor Fernando Martins do Vale, Instituto de Farmacologia/Neurociências, Faculdade de Medicina da Universidade de Lisboa, Lisboa 1649-028, Portugal; fmvale{at}

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The work of Behrens et al 1 is an interesting prospective study about sedation-related complications during GI endoscopic procedures, which by the large number of patients involved allows a reliable analysis of their rates and associated risk factors. Major complications occurred more frequently on sedated patients (0.01%) than on non sedated patients (0.007%), with a mortality rate of 0.004% with sedation and only 0.002% without sedation. The majority of complications were respiratory, and of the 38 patients with major complications, 26 required intubation and 13 died.1 It may be useful to look over the pharmacological properties of the selected drugs as a way to predict and avoid adverse outcomes, especially respiratory failure.

The majority of authors use benzodiazepines (midazolam) or propofol, which are GABAergic drugs able to induce a dose-dependent depression of …

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  • Contributors FMdV (corresponding author) and DFM are the only contributing authors of this letter.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Author note This work is only a comment to a paper published on Gut: Behrens A, Kreuzmayr A, Manner H, et al. Acute sedation-associated complications in GI endoscopy (ProSed 2 Study): results from the prospective multicentre electronic registry of sedation-associated complications. Gut 2018; 0:1–8.