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Chapter 1
As example for such a procedure we chose endoscopic colonoscopies. Colonoscopies are
often associated with pain and fear. Dominitz et al.
10
could show that 25% of all people
who never have had a colonoscopy before are willing to surrender median ninety days of
their resting life to obviate this expected painful and scary procedure even if it is necessary.
However, there are also patients where it is possible to perform a successful colonoscopy
without any form of sedation.
11,12,13
But even this latter group stated that there are moments
during the procedure with enormous discomfort
14
and painful episodes. Our review follows
Moerman’s hypothesis: “If pain is the crucial point, why do we need sedation?”
15
and we
discuss the analgesic options to increase success-rates of a painful intervention without
increasing risks due to sedation-induced adverse events.
16,17
Part 2
In part 2 of this thesis we discuss different drugs for analgo-sedation and their application
during different procedures with special requirements concerning sedation.
The definition “sedation” is not unambiguous. It is a collective term for a drug-induced
continuum ranging from consciousness to unconsciousness of the patient with all possible
side effects like loss of airway patency or cardiovascular instability.
Sedation levels range from minimal to moderate, to deep sedation, and finally to general
anaesthesia.
18
A clear understanding of this continuum is mandatory.
19
During minimal sedation patients respond in a normal way
to verbal commands.
Cardiorespiratory functions are unaffected, whereas the cognitive functionmay be impaired.
Moderate sedation is specified as further reduction of cognitive function. Patients could
purposefully respond to verbal commands after light tactile stimulation. Spontaneous
ventilation is completely sufficient.
During deep sedation, cognitive function is further reduced, and patients cannot be easily
awaked, but react on repeated or painful stimuli. Spontaneous ventilation can be insufficient.
It may be necessary to assist patients to maintain airway patency. Cardiovascular functions
are normally unimpaired.
General anaesthesia means: patients are not arousable, even not after a painful stimulus.
Assistance tomaintain a patent airway and positive-pressure ventilation are often necessary.
Analgo-sedation is a combination of analgesia and one of these above-mentioned sedation
levels.
Therefore, it is important for each procedure to estimate, which component (analgesia and/
or sedation) and also which level of sedation is really necessary and which could be passed.
We should always consider, what is important for the respective procedure: is it the stress-
free, the painless, the immobile, or the non-coughing patient?