1. Safety and monitoring should be part of a quality assurance programme for endoscopy units.  (C)
  2. Resuscitation equipment and sedation reversing/antagonist drugs must be available in the endoscopy room and recovery area.  (C)
  3. Drugs and equipment necessary for the maintenance of airway, breathing and circulation should be present in the endoscopy room and recovery area and be checked regularly.  (C)
  4. A qualified nurse trained in endoscopic techniques and rescusitatory techniques should monitor the patient’s condition during procedures.  (C)
  5. Staff of all grades and description should be familiar with resuscitation methods and undergo periodic re-training.  (C)
  6. Prior to endoscopy, risk factors should be identified in both out-patients and in-patients.  (C)
  7. Endoscopy is sometimes an emergency procedure, so high-risk patients should be resuscitated as much as possible before attempting the procedure.  (C)
    • a).    Dosage of benzodiazepines and opiates should be kept to a minimum to achieve sedation and should be within the manufacturers guidelines.  (C)
    • b) Opioids should, whenever possible, be given before benzodiazepines and their effect observed before proceeding.  (B)
    • c)    Most endoscopic practices recommend that 5 mg of Midazolam should usually be the maximum dose given and that elderly patients are given 1-2 mg initially with a sensible pause to observe effect.  Doses in excess of Pethidine 50mg or Fentanyl 100 mcg are seldom required and elderly patients will require dose reduction (usually below 50%) when these drugs are used.  (C)
  8. All sedated patients must have a flexible (not “butterfly” ) intravenous cannula in situ throughout the procedure and recovery period.  (C)
  9. Oxygen should be given to all sedated patients and selected unsedated patients throughout the procedure and recovery period. (C)
  10. The endoscopist is responsible for the health and safety of the patient throughout the procedure and is not just a technician.  (C)
  11. Pulse oximetry monitoring should be used in all sedated patients and ECG and blood pressure monitoring should be readily available for high risk patients.   (C)
  12. Clinical monitoring must be continued into the recovery area.  (C)
  13. Records of management outcome and adverse events should be taken as part of the patient plan and kept and used for audit of departmental practice.  (C)