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Practice recommendations for the use of sedation in routine hospital-based colonoscopy
  1. Fahima Dossa1,2,
  2. Catherine Dubé3,4,
  3. Jill Tinmouth2,4,5,
  4. Anne Sorvari6,
  5. Linda Rabeneck4,5,
  6. Bronwen R McCurdy4,
  7. Jason A Dominitz7,
  8. Nancy N Baxter1,2,4,6
  1. 1Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
  2. 2Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
  3. 3Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
  4. 4Cancer Care Ontario, Toronto, Ontario, Canada
  5. 5Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
  6. 6Department of General Surgery, St Michael's Hospital, Toronto, Ontario, Canada
  7. 7Department of Medicine, Division of Gastroenterology, VA Puget Sound Health Care System and University of Washington School of Medicine, Seattle, Washington, USA
  1. Correspondence to Dr Fahima Dossa; fahima.dossa{at}


Objective Although sedation improves patient experience during colonoscopy, there is great jurisdictional variability in sedative practices. The objective of this study was to develop practice recommendations for the use of moderate and deep sedation in routine hospital-based colonoscopy to facilitate standardisation of practice.

Design We recruited 32 multidisciplinary panellists to participate in a modified Delphi process to establish consensus-based recommendations for the use of sedation in colonoscopy. Panel members participated in a values assessment survey followed by two rounds of anonymous online voting on preliminary practice recommendations. An inperson meeting was held between voting rounds to facilitate consensus-building. Consensus was defined as >60% agreement/disagreement with recommendation statements; >80% agreement/disagreement was considered indicative of strong consensus.

Results Twenty-nine panellists participated in the values assessment survey. Panellists ranked all factors presented as important to the development of practice recommendations. The factor considered most important was patient safety. Patient satisfaction, procedural efficiency, and cost were considered less important. Strong consensus was achieved for all nine practice recommendations presented to the panel. These recommendations included that all endoscopists be able to perform colonoscopy with moderate sedation, that an endoscopist and a single trained nurse are sufficient for performing colonoscopy with moderate sedation, and that anaesthesia-provided deep sedation be used for select patients.

Conclusion The recommendations presented in this study were agreed on by a multidisciplinary group and provide guidance for the use of sedation in routine hospital-based colonoscopy. Standardised sedation practices will promote safe, effective, and efficient colonoscopy for all patients.

  • endoscopy
  • colonoscopy
  • screening

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  • Contributors Conception and design: FD, CD, JT, AS, LR, BM, NB. Analysis and interpretation of data: FD, AS, JAD, NB. Drafting of the article: FD. Critical revision of the article for important intellectual content: FD, CD, JT, AS, LR, BM, JAD, NB. Final approval of the article: FD, CD, JT, AS, LR, BM, JAD, NB.

  • Funding This study was funded by the Canadian Institutes of Health Research (CIHR) Foundation Grant (no 148470) and with the support of Cancer Care Ontario (CCO) through funding provided by the Government of Ontario. The opinions, results, view, and conclusions reported in this publication are those of the authors and do not necessarily reflect those of Cancer Care Ontario.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval This study was approved by the Research Ethics Board at St Michael’s Hospital.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.

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