One death per 2000 procedures demands action

Diagnostic and therapeutic endoscopy are often carried out under sedation, and recommendations to increase their safety have been made.1 2 Because desaturation is common during upper gastrointestinal endoscopy these recommendations include the routine use of oxygen supplementation and measurement of arterial oxygen saturation by a pulse oximeter.3 4 The recommendations regarding monitoring are less rigorous than those suggested by anaesthetists, yet it is difficult to understand why.

Standards for monitoring during anaesthesia and recovery, published by the Association of Anaesthetists of Great Britain and Ireland in 1988, were revised last year.5 These recommend that clinical monitoring should be supplemented by devices that continuously display the heart rate, pulse volume or arterial pressure, oxygen saturation, and electrocardiogram. Furthermore, they recommend strongly that oxygen saturation should be measured until the patient meets the criteria for discharge from the recovery area. Importantly, the recommendations emphasise that the same standards of monitoring should be applied to regional anaesthesia and sedative techniques when there is a risk of unconsciousness or …