Importance of pharmacology to avoid complications with endoscopic sedation

The work of Behrens et al1 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 the central nervous system that may eventually result in respiratory failure, which may be caused by two...

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