Sedation is a difficult concept to define, as it includes a continuum from anxiolysis to anaesthesia. The point at which sedation becomes anaesthesia is generally accepted as occurring when the patient becomes unresponsive to verbal commands.1-3 Sedation is a depression of, rather than a loss of, consciousness, and may be combined with analgesia and amnesia to facilitate otherwise unpleasant and painful procedures. There is a large demand for sedation with endoscopy in Australia, although this is not universal practice.4 For instance, most colonoscopies in Germany are performed without sedation.
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- Department of Anaesthesia, Royal North Shore Hospital, St Leonards, NSW.
- 1. Australian and New Zealand College of Anaesthetists. Guidelines on conscious sedation for diagnostic, interventional medical and surgical procedures. Melbourne: ANZCA, 2001. (ANZCA Professional Document P9.) Available at: http://www.anzca.edu.au/pdfdocs/PS9_2001.pdf (accessed January 2002).
- 2. Practice guidelines for sedation and analgesia by non-anesthesiologists. Park Ridge, Ill: American Society of Anesthesiologists, 2001. Available at: http://www.asahq.org/publicationsAndServices/sedation1017.pdf (accessed June 2005).
- 3. Implementing and Ensuring Safe Sedation Practice for Healthcare Procedures in Adults. Report of the Intercollegiate Working Party of the UK Academy of Medical Royal Colleges and their Faculties. London: Academy of Medical Royal Colleges, 2001. Available at: http://www.aomrc.org.uk/RCA%20SSP.pdf (accessed January 2002 - no longer available).
- 4. Bell GD, Charlton JE. Colonoscopy — is sedation necessary and is there any role for intravenous propofol? Endoscopy 2000; 32: 264-267.
- 5. Quine MA, Bell GD, McCloy RF, et al. Prospective audit of upper gastrointestinal endoscopy in two regions of England: safety, staffing and sedation methods. Gut 1995; 36: 462-467.
- 6. Davis NJ, editor. Anaesthesia related mortality in Australia 1994–1996. Melbourne: Australian and New Zealand College of Anaesthetists, 1999. Available at: http://www.anzca.edu.au/publications/reports/mortality/mort_94_1.htm (accessed January 2002).
- 7. Clarke AC, Chiragakis L, Hillman LC, Kaye GL. Sedation for endoscopy: the safe use of propofol by general practitioner sedationists. Med J Aust 2002; 176: 158-161. <eMJA full text>