Division of Gatroenterology and Hepatology, Department of Internal Medicine, Chonbuk National University Hospital and Medical School, Jeonju, Korea
ABSTRACT
Although incidence of sedation-related complication has been known low, it is closely related with endoscopy related morbidity and mortality. With an advance of endoscopic retrograde cholangiopancreatograpy (ERCP) technique and increased aging of population, the need of procedure to high risk patients such as myocardial ischemia is increasing. To prevent sedation-related complication, identification of high risk patients with adequate history taking and physical examination is mandatory. Adequate monitoring of the patient during sedation is also essential for early detection and prompt management of sedation related complication including hypoxemia and myocardial ischemia. Pulse oximetry is the most commonly used monitoring method and very useful to detect hypoxemia. With the adoption of capnography, inadequate rate or depth of respiration, and upper airway obstruction can be identified before substantial hypoxemia occurrence. Hemodynamic monitoring should be performed regularly. ECG monitoring is recommended in selected patient who has cardiovascular risk. A well educated, specialized person is recommend for monitoring so endoscopist can concentrate the procedure only. Adequate emergency equipments and pharmacologic agents are also should be prepared.
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