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Changing patterns of sedation and monitoring practice during endoscopy: results of a nationwide survey in Switzerland.

BACKGROUND AND STUDY AIMS
Little is known about how practices in sedation and in monitoring during gastrointestinal endoscopy and the complication rates of sedation have changed over time. The aim of this nationwide survey was to assess the present practice among Swiss gastroenterologists, with a particular focus on the use of propofol, and to compare the results with similar data obtained in 1990.


PATIENTS AND METHODS
At the end of 2003 a questionnaire (similar to the one used in 1990) was sent to all 249 Swiss gastroenterologists. The response rate was 72.3 %. Data from 179 953 endoscopies performed during the previous 12 months were analyzed for the study.


RESULTS
In 2003 sedation was used in 78 % of esophagogastroduodenoscopies and colonoscopies (compared with 60 % in 1990), with midazolam being the most commonly used medication. The drugs were mostly administered by the endoscopy nurse, via an intravenous cannula. Oximetry monitoring was used in more than 95 % of examinations (compared with 2.5 % in 1990). The overall sedation-related morbidity was 0.18 % and the mortality rate was 0.0014 %. Of the 180 respondents, 77 (43 %) reported that they been using propofol regularly for a median time period of 23 months. The 62 respondents (34 %) who used propofol without the assistance of an anesthesiologist had performed a total of 82 620 procedures. The morbidity (defined as the need for bag-ventilation) in this group of patients was 0.19 % and no deaths were reported.


CONCLUSIONS
The use of sedation in gastrointestinal endoscopy has markedly increased over the last 13 years and the use of electronic monitoring has become standard practice. A significant percentage of Swiss gastroenterologists report that they use propofol, mainly in a hospital setting.