Gastroenterology - Conscious sedation for an Endoscopy procedure

This leaflet explains what sedation is, how it works during your endoscopy procedure. It also explains both the benefits and risks of using sedation and what it might feel like. Importantly, it tells you what you will need to plan for your care after sedation.

What is intravenous sedation?

Intravenous sedation is when a sedative to relax you is injected into your bloodstream using a needle and a small plastic tube (also called a cannula) usually placed in a vein in your arm or hand. The endoscopists are trained to give the right amount of sedative and manage any side effects. During and after your endoscopy the nursing staff will monitor your breathing and oxygen levels.

What is conscious sedation?

Conscious sedation (Midazolam) is when a drug is administered (given) to help you feel more relaxed during the endoscopy procedure. The drugs (sedative Midazolam) is given directly into your vein via a canular inserted into a vein in your arm during the admission process.

You will be given a small amount of a sedative drug called Midazolam. This will make you feel relaxed and less worried by what is happening around you. You will be awake and able to talk normally. You are likely to remember having the endoscopy, but not all the detail, minimal sedation should not affect your breathing, though during and after your endoscopy procedure under sedation you will be administered oxygen via your nose by a nasal tube. This will remain in place until the nurses on the recovery unit deems you have fully recovered so this can be removed without issue.

What are the benefits of conscious sedation?

Sedation works quickly and the dose will be adjusted by the endoscopists, so you receive just the right amount. This allows you to be relaxed during your endoscopy. One of the effects of the drug is that you may not remember much about your procedure afterwards. Recovery from conscious sedation is quicker than after a general anaesthetic, so you can usually go home within an hour or two of your procedure and once you feel well enough.

What does conscious sedation feel like?

This will vary from person to person and depending on how much of the drug is administered to achieve light/ mild conscious sedation. You will usually feel pleasantly relaxed and slightly detached from what is occurring around you.

What can I do to prepare for a procedure with sedation?

• If you have people that you look after, for example children or older people, you will need to plan for someone else to look after them until the day after the procedure (24 hrs)
• A responsible adult will need to take you home by car or taxi ideally – using public transport is not advised after conscious sedation
• As the effects of sedation can last up to 24 hours, therefore the responsible adult should stay overnight to look after you
• Take all your medicines to hospital with you, including any inhalers and any over-the-counter medicines you take regularly
• If you have an illness or a cold, or you are pregnant or breast feeding, please contact your hospital or clinic, as it may not be safe to have sedation as your procedure may have to be rearranged
• Remove all makeup – including nail varnish and jewellery – before coming to the hospital unit. You may wear a wedding ring
• Bring some loose clothing, such as a dressing gown or a fleece, to keep you comfortable and warm. Wear flat shoes that are easy to put on

After Care advise for Conscious sedation

• Your ability to make decisions and judgements may be affected for up to 24 hours after administration of conscious sedation, therefore, you should avoid making any important decisions during that time
• You should avoid posting on social media/public forums too
• You should not return to work, look after dependants, drive, cook or operate any machinery for 24 hours, as it may take this length of time for the drugs to leave your body
• You should not take any alcohol or sleeping tablets for 24 hours after the procedure
• The endoscopy nurses will give you written instructions about endoscopy post sedation advise on discharge from the endoscopy unit to take home. This will include contact telephone numbers to call if you feel unwell at home
• If after the procedure you are concerned, feel unwell, or cannot find the hospital contact number, you can call your GP, ring 111/999 or go to your local accident and emergency department with a capable adult if necessary

Side effects, complications, and risks in conscious sedation

• Serious problems are very uncommon, though risks cannot be removed completely, but modern drugs, equipment and training have made sedation much safer in recent years
• All the endoscopy staff take a lot of care to avoid all the risks outlined. They will be able to give you more information about any of these risks and what they do to avoid them.

Risks during your sedation are:

• Your breathing rate may become slow, therefore supplementary oxygen is administered. All endoscopy staff are trained and skilled in monitoring you and can support your breathing if required.
• It is very common for your blood pressure to drop by a small amount, but again all the endoscopy staff are skilled/trained in treating this too
• It is very common to be left with a small bruise where your cannula was placed
• There is a rare risk of stomach contents going into your lung. This is called aspiration, so to help avoid this, the endoscopy nurse would use suction to clear your mouth and airway
• It is important to follow the instructions for eating and drinking to keep this risk very low. Any allergic reaction to the sedation drugs is very rare

Risks after your sedation

It is very common to feel drowsy and less steady on your feet. You may be at higher risk of falling, especially if you are elderly.