Practical Gastrointestinal Endoscopy

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CHAPTER 3
Antagonists
Meperidine® can be reversed by naloxone, given both intramuscularly
(IM) and intravenously (IV). Benzodiazepines are
reversed by flumazenil, given by slow IV injection. Both antagonists
have shorter half-lives than the drugs they antagonize.
Anesthesia
Although the vast majority of standard upper endoscopy procedures
can be performed with endoscopist-directed sedation (or
with no sedation), there are circumstances where the presence of
an anesthesiologist is helpful, and some in which full anesthesia
is required. Examples include young children, heavy drinkers,
patients who are difficult to sedate, and patients with high-risk
cardiopulmonary status. Propofol (Diprivan®) is a useful shortacting
anesthesia agent that seems ideal for endoscopy procedures.
In most centers and countries this can be given only by
anesthesiologists.
Numerous other sedation/anesthesia practices have also been
tested and used, for example patient-controlled nitrous oxide,
and acupuncture.
Other medications
Pharyngeal anesthesia (given by spray) is used in many units.
Avoid asking the patient to say ‘ah’, since this exposes the larynx
also to anesthesia, and may suppress the cough reflex. Some
avoid local anesthesia when using sedation, believing that it
may increase the risk of aspiration.
Excessive intestinal contraction can be suppressed with intravenous
injections of glucagon (increments of 0.25·mg up to 2·mg),
or hyoscine butylbromide (Buscopan®) 20–40·mg, in countries
where it is available.
Silicone-containing emulsions can be given to suppress foaming
in the stomach—either swallowed before the procedure, or
injected down the endoscope channel.
RECOVERY AND DISCHARGE
After the endoscope is removed, the assisting nurse checks on
the status of the patient, and then transfers care to the recovery
area staff. Monitoring is continued until the patient is fully
awake, usually 20–30·minutes after standard sedation. A longer
period of observation is necessary after general anesthesia.
A drink is appreciated after the sedation and any pharyngeal
anesthesia has worn off. When established discharge criteria
are met, the patient dresses and is taken to an interview area to
discuss the findings and further care. Endoscopy is not complete