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Nurses endoscopists criticise sedation claims

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Nurse endoscopists have hit back at claims that they are putting patients at risk by oversedating them during interventional procedures.

Moderate sedation is commonly used for patients undergoing gastrointestinal investigations, such as colonoscopy and endoscopy. Often delivered by specialist nurses, its aim is to allow patients to remain conscious and respond to verbal and tactile stimulation.

But, according to a US study, most patients receiving nurse-delivered sedation are being sedated to levels consistent with general anaesthesia, putting them at risk of adverse events such as oxygen desaturation and hypotension.

The researchers studied 595 patients who were undergoing interventional procedures including endoscopy, colonoscopy and bronchoscopy. They found that 78% of patients who received nurse-delivered sedation lost consciousness for at least 5min during the procedure.

Lead study author Tong Gan, anaesthesiologist at the Duke University Medical School in North Carolina, said nurses delivering sedation should ensure that they monitor patients and should be trained in the use of sedation drugs.

‘Findings suggest that a high percentage of patients who received nurse-delivered sedation were in the range that is compatible with general anaesthesia, increasing the possibility of risk,’ he said.

But Ian Fretwell, nurse consultant in colorectal and endoscopy at Chesterfield Royal Hospital NHS Foundation Trust in Derbyshire, said it made no difference whether sedation was delivered by a nurse, doctor or non-medical endoscopist.

‘Anaesthetists have always had issues with sedation, whoever the administering practitioner is,’ he said. ‘All UK endoscopists have to adhere to the same guidelines set out by the British Society of Gastroenterology and practice is continually monitored and assessed for safety.

‘Training for nurses has set the standard for sedation safety but, as usual, nurses have had to jump through higher hoops to gain credibility and be considered safe to practise,’ he added.

  • 3 Comments

Readers' comments (3)

  • I had an endoscopy and decided to stay awake though out and was delghted to remember it. A few weeks later i had a colonoscopy and was sedated but never remembered any of it and slept for a good while after it. i would have prefered to be half a wake.

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  • Rather late in the day to be commenting but see NT continence blog July 2009. I've had both procedures and had sedation for both. Neither were at anaesthetic levels and I really did appreciate not be 100% aware. The nurses were excellent, all I can say is well done and obviously trained well.

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  • As per previous comment, this is (very) late in the day but I came across this item while researching.

    As a nurse endoscopist within the UK, I have to ask is this not comparing apples to oranges? The study was carried out in America and therefore the findings are not pertinent for UK. As Mr Fretwell points out in the article, we have clinical bodies who oversee the practice and safety of ALL endoscopists by ensuring robust training and monitoring. There are also requirements for local monitoring all of which counts to both the endoscopists and their hospital/board of practice's compliance with GRS and JAG accreditation. The sedation used in endoscopy is termed as 'concious sedation' which speaks for itself, and the training given reflects this.
    Perhaps it is time for a more up-to-date UK audit....

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