**7.2 Training for sedation**

Appropriate supervision and training is critical for developing skills necessary to perform conscious sedation. There is uniform agreement in the literature and all relevant societal guidelines agree that specific training is needed for both endoscopic procedure and any sedation associated with the procedure (America Society of Anaesthesiologists 2002, ASGE 2008, Cohen et al 2007).

### **7.3 Situation in developing countries**

There are no published studies on the use of sedation in most African countries including Nigeria. This is partly because there are no guidelines in place to regulate the use of sedation in gastrointestinal endoscopy. Similarly the rate and type of sedation employed by endoscopists in these countries is not known. However, it is tempting to assume that endoscopists in developing countries either undersedate their patients or avoid sedation all together in order to avoid the attendant increase in cost and increase in complications.This is because the endoscopists do not have any special training in the use of sedatives and the centres where they work do not always have the basic facilities to monitor patients adequately during the procedures. One consequence of this situation is that patients who find the procedure seriously unpleasant because they were not sedated may not only refuse future examination but spread concern to others. A meta-analysis showed sedation to achieve better patient cooperation and satisfaction and willingness to have it repeated. (McQuaid et al 2008).
