**Abstract**

Gastrointestinal endoscopy has become fundamental procedure for diagnosis and treatment of gastrointestinal tract diseases. Generally, the gastrointestinal endoscopy is minimally invasive procedure. However, it can cause considerable amount of discomfort and pain which make the procedure unsafe, complicated and refusal of follow up procedures if done without safe sedation. The sedation is required to alleviate anxiety, provide analgesia, amnesia and to improve endoscopic performance specifically in therapeutic procedures. The safe administration of sedative and analgesic medications, irrespective of the regimen used, requires knowledge of the individual needs of patients. The combination of benzodiazepines and opioids is now the most widely used sedation regimen for sedation in gastrointestinal endoscopic procedures. Generally, sedation for gastrointestinal endoscopy is considered safe, however, it has the potential for serious complications. Therefore, endoscopist should assess the patients properly before the endoscopy as well as should be aware of all possible complications and the risk factors. Furthermore, skilled staff and emergency equipment should be available in endoscopy suit. This chapter discuss in details all the aspects of safe procedural sedation during GI endoscopies.

**Keywords:** sedation, analgesia, gastrointestinal endoscopy, monitoring

#### **1. Introduction**

With the advancement in the field of medicine there is a consistent increase in number of diagnostic and therapeutic procedures which are done as day care basis. These procedures can cause considerable amount of discomfort and pain which make the procedure unsafe, complicated and refusal of follow up procedures if done without safe sedation. The GI endoscopies are a kind of procedures that need sedation to facilitate the procedures, alleviate discomfort, pain and eventually making them safe and successful.

Sedation is drug induced depression of the conscious level; it is also call as procedural sedation. Sedation is a continuum ranging from minimal sedation i.e., anxiolysis, moderate sedation (also known as Conscious sedation), Deep sedation and finally general anesthesia. Sedation for GI endoscopy needs proper planning

like preprocedural preparation, risk assessment, focus physical examination and optimization of comorbid condition if any. Other considerations in the sedation managements like the selection of a suitable sedation, analgesia regimen depends on the type and duration of procedure, patient and endoscopist satisfaction and last not the least on the competency of the provider. Monitoring during procedure is one of the crucial points in the safe sedation practice. The post procedure care is an essential part of patient safety which need monitoring of the patient in the recovery area where the adverse events secondary to the procedure or the sedation can be discovered and addressed promptly.
