Introduction
In modern medicine, the increasing number and complexity of diagnostic and therapeutic endoscopic procedures require more controlled and optimized working conditions, thus making sedation a crucial component of these procedures. Sedation is a pharmacologically induced, reversible state of reduced consciousness, used during medical procedures to reduce discomfort, anxiety, and pain in patients. Given the ethical principle of rejecting unnecessary pain, the use of sedation is a cornerstone of humane and dignified healthcare.
Results & Findings
The most commonly used sedatives are midazolam and remimazolam. Remimazolam is a new short-acting intravenous sedative from the benzodiazepine class.
Approved in Croatia in 2021 for procedural sedation, a study was conducted on 43 participants at the Clinical Hospital Centre Sestre milosrdnice during esophagogastroduodenoscopy and colonoscopy to evaluate patient satisfaction and sedation efficacy. The average age of the participants was 57 years. According to the Brice questionnaire, remimazolam was sufficient to achieve the desired sedation level in 32 patients, while only a smaller number required additional propofol administration. Side effects were minimal and rare, such as mild bradycardia.
Patient satisfaction was high, and medical staff also reported ease of application.
A significant advantage is that, in many countries, the administration of sedatives does not require the presence of an anesthesiologist alongside the gastroenterologist, as is the case in Croatia.
Summary & Discussion
The use of sedatives carries the risk of hemodynamic and respiratory complications, requiring preparedness for managing emergencies. It is crucial to understand the responsibilities of all healthcare team members, particularly the nurse, who plays a pivotal role in ensuring patient safety during the sedation process.
The nurses' tasks include preparation of sedatives, physiological solutions, monitoring equipment (pulse oximeter, ECG, blood pressure monitor), basic oxygen therapy, and availability of antidotes (flumazenil) and emergency medications.
During the procedure, the nurse performs continuous monitoring of vital signs and must react promptly in case of complications such as hypotension, bradycardia, or respiratory depression. The successful response includes correct patient positioning, airway management, therapy administration, and preparedness for CPR.
Collaboration between nurses and doctors is key, as is calm and rapid decision-making.
Conclusion
Sedation plays an irreplaceable role in enabling safe, effective, and comfortable gastroenterological endoscopy. For successful outcomes, it is necessary to ensure appropriate education, competence, and coordination of all healthcare team members.
The nurses response in emergency situations significantly contributes to the safety and success of procedures under sedation.
References
M. Škrtić, L. Lijović, N. Kovač, I. Pažur, B. Bodulica, N. Periša, O. Ožegić, M. Vučić, T. Radoča “Remimazolam: Patient satisfaction and safety for procedural sedation”
Remimazolam: Patient satisfaction and safety for procedural sedation
American Society of Anesthesiologists “Practice Guidelines for Moderate Procedural Sedation and Analgesia 2018”
Anesthesiology
