Poster (15W208)

How much is enough? A study of patient expectations on sedation for endoscopy


Dr Padraic McDonagh, Dr Eoin Slattery


Gastroenterology, Galway University Hospital


“Conscious sedation” is defined by the ASGE as a level of moderate sedation, whereby the patient, while maintaining ventilatory and cardiovascular function, is able to make purposeful responses to verbal or tactile stimulation. Little is known about patient expectations and perceptions surrounding level of sedation for endoscopic procedures. Anecdotal evidence would suggest that Irish patients expect a higher level of sedation than that which they experience. Our aim was to formally assess expectations and perceptions of sedation and where possible to identify patients at higher risk of unsatisfactory outcomes with respect to sedation and overall experience.


We prospectively recruited patients attending for day case endoscopy at a large tertiary referral hospital. Patients were asked to complete a questionnaire surrounding their expectations with respect to level of sedation they expected to receive using a visual analogue scale (VAS). Pre-morbid depression/anxiety and possible concomitant functional disease were measured using pre-validated psychometric tools (Perceived Stress Scale and Visceral Sensitivity Index). Patients were contacted post procedure to assess their overall experience using a Likert Scale.


Levels of expectation regarding sedation were high with patients expressing a median value of 8/10 (on a scale of 1:10, 10 being completely asleep). When subsequently asked about their wishes a median value of 9/10 was recorded. With half of patients surveyed stating that they wished to be completely asleep for the procedure. Post-procedure self reported comfort median values were 6/10 (10 being very comfortable). Interestingly, 77% of patients had undergone previous endoscopy. The vast majority of patients were willing to undergo repeat procedure if needed; only 6% said they were not happy to undergo another procedure. However, 45% of patients wanted more sedation at their next procedure. Concomitant anxiety was common in patients undergoing endoscopy with 27% scoring a PSS>19, indicating high anxiety and stress. Unsurprisingly there reported comfort scales were lower (4/10 vs. 6/10) and 71% of this group would like more sedation in any future procedures. Median midazolam dosage in this group was 3mg (compared to 4mg in the entire cohort).


Sedation practices (with respect to overall dosages and nurse/endoscopist perceived comfort) are commonly used as markers of quality of performance of endoscopy. Patient experience is often not considered. Our results show that patient knowledge about perceptions surrounding sedation is poor, despite previous personal experience and institutional literature specifying the level of sedation used. Nevertheless, patient comfort and acceptability of procedure should not be forgotten in our clamour to ensure both high quality and safe endoscopic practices.