Table 1

Results of small group sessions

Who may need deep sedation for routine colonoscopy?*
Patient factorsContextual factors
  • Chronic opiate users.

  • Patients who have failed with moderate sedation in the past due to discomfort.

  • Hypersensitivity to vomiting and nausea.

  • History of sexual abuse.

  • Selection of patients with irritable bowel syndrome, fibromyalgia, or previous diverticulitis.

  • Patients with cognitive disabilities (eg, dementia).

  • Paediatric patients.

  • Anaesthesiologist on hand/readily available.

    • Smaller centres/hospitals may depend on anaesthesiologist as a revenue stream.

    • May use anaesthesiologists because they need to provide them with enough cases to keep them employed.

  • Patient preference.

  • Lengthy/complex procedure (eg, endoscopic mucosal resection).

  • Skill level of endoscopist.

  • Patient is alone.

How do we enhance patient experience under moderate sedation?
Prior to the procedure
  • Provide a friendly, clean environment for the patient.

  • Educate the patient regardless of the sedation they will receive (standardised learning materials).

    • Information about what to expect before, during, and after procedure.

    • Start educating the patient as early as possible.

    • Train all staff in proper education protocols.

  • Prepare the patient for possibility of pain/discomfort.

  • Communicate and listen to the patient.

    • Address concerns and answer questions.

    • Build rapport.

    • Address language barriers, if necessary.

  • Continual education/improvement for medical staff.

  • Skill-enhancing courses for endoscopists and nurses.

  • Ensure patients have a safe way home.

During the procedure
  • Ensure the patient is comfortable (temperature of the room, choice in music, etc).

  • ‘Time out’ before, during, and after the procedure where patient information (including relevant comorbidities and allergies), indications for the procedure, equipment required, findings, etc are reviewed.

  • Use of anxiolytics to minimise recall of pain, when necessary.

  • Communicate with the patient during the procedure (warn about any discomfort they might feel).

  • Allow family member in the room with certain patients (eg, patients who are hearing impaired).

  • Skilled intravenous (IV) placement.

  • Patient-controlled sedation.

  • Titration of sedation dosage.

  • Start the patient lightly sedated and increase sedation, if necessary.

  • Use of abdominal pressure and variation in patient positioning.

  • Use carbon dioxide instead of air.

    • Carbon dioxide helps in the recovery phase.

    • Patients report less pain following procedure.

  • Use of a scope guide.

After the procedure
  • Confirm that patients have a safe way home.

  • Provide next-day call or follow-up appointment.

    • Emphasise that patient feedback is important and how it is used to improve patient experience.

  • Provide contact information for patients to contact with questions or concerns.

  • Patient rating cards provided to endoscopist (the patient rates comfort level during the procedure).

  • Use patient feedback to improve.

  • Members of the multidisciplinary panel participated in two small group sessions during an inperson consensus-building meeting. The first small group session explored patient and contextual factors that may warrant the use of deep sedation in specific circumstances. The second small group session focused on how to improve patient experience under moderate sedation.

  • *The patient and contextual factors listed here are not meant to imply that deep sedation should be used if any of these factors are present. Rather, if ≥1 of these factors are present, endoscopists should consider, on a case-by-case basis, whether deep sedation is necessary.