Ann Acad Med Singap Vol 51 No 1 January 2022 | annals.edu.sg Academy of Medicine, Singapore clinical guideline on the use of sedation by non-anaesthesiologists during gastrointestinal endoscopy in the hospital setting Tiing Leong Ang 1 FAMS, Edwin Seet 2 FAMS, Yaw Chong Goh 3 FAMS, Wee Khoon Ng 4 FAMS, Calvin Jianyi Koh 5 FAMS, Hock Foong Lui 6 FAMS, James Weiquan Li 1 FAMS, Aung Myint Oo 7 FAMS, Kieron Boon Leng Lim 3 FAMS, Kok Sun Ho 3 FAMS, Min Hoe Chew 8 FAMS, Wai Leong Quan 9 FAMS, Damien Meng Yew Tan 10 FAMS, Kheng Hong Ng 6 FAMS, Hak Su Goh 6 FAMS, Wai Kit Cheong 11 FAMS, Philip Tseng 3 FAMS, Khoon Lin Ling 3 FAMS 1 Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore 2 Department of Anaesthesia, Khoo Teck Puat Hospital, Singapore; Department of Anaesthesia, National University of Singapore 3 Mount Elizabeth Medical Centre, Singapore 4 Department of Gastroenterology and Hepatology, Tan Tock Seng Hospital, Singapore 5 Department of Gastroenterology and Hepatology, National University Hospital, Singapore 6 Gleneagles Medical Centre, Singapore 7 Department of General Surgery, Tan Tock Seng Hospital, Singapore 8 Department of General Surgery, Sengkang General Hospital, Singapore 9 Royal Square Medical Centre, Singapore 10 Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore 11 Department of Surgery, National University Hospital, Singapore Correspondence: Dr Khoon Lin Ling, Mount Elizabeth Medical Centre, 3 Mount Elizabeth, Singapore 228510. Email: drlingkl@gmail.com Prof Tiing Leong Ang, Department of Gastroenterology and Hepatology, Changi General Hospital, 2 Simei Street 3, Singapore 529889. Email: ang.tiing.leong@singhealth.com.sg REVIEW ARTICLE ABSTRACT Introduction: In Singapore, non-anaesthesiologists generally administer sedation during gastrointestinal endoscopy. The drugs used for sedation in hospital endoscopy centres now include propofol in addition to benzodiazepines and opiates. The requirements for peri-procedural monitoring and discharge protocols have also evolved. There is a need to develop an evidence-based clinical guideline on the safe and effective use of sedation by non-anaesthesiologists during gastrointestinal endoscopy in the hospital setting. Methods: The Academy of Medicine, Singapore appointed an expert workgroup comprising 18 gastroenterologists, general surgeons and anaesthesiologists to develop guidelines on the use of sedation during gastrointestinal endoscopy. The workgroup formulated clinical questions related to different aspects of endoscopic sedation, conducted a relevant literature search, adopted Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology and developed recommendations by consensus using a modifed Delphi process. Results: The workgroup made 16 recommendations encompassing 7 areas: (1) purpose of sedation, benefts and disadvantages of sedation during gastrointestinal endoscopy; (2) pre-procedural assessment, preparation and consent taking for sedation; (3) Effcacy and safety of drugs used in sedation; (4) the role of anaesthesiologist-administered sedation during gastrointestinal endoscopy; (5) performance of sedation; (6) post-sedation care and discharge after sedation; and (7) training in sedation for gastrointestinal endoscopy for non-anaesthesiologists. Conclusion: These recommendations serve to guide clinical practice during sedation for gastrointestinal endoscopy by non-anaesthesiologists in the hospital setting. Ann Acad Med Singap 2022;51:24-39 Keywords: Benzodiazepines, gastrointestinal endoscopy opiates, propofol, sedation Ann Acad Med Singap 2022;51:24-39 https://doi.org/10.47102/annals-acadmedsg.2021306