Pharmacological sedation strategies for therapeutic gastrointestinal endoscopy: a systematic review and network meta-analysis of randomised controlled trials

Key Takeaways for GI Nurses

• This systematic review provides evidence-based guidance for selecting optimal sedation protocols specifically for therapeutic endoscopic procedures, which often require deeper sedation and longer procedure times than diagnostic cases
• Network meta-analysis methodology allows for comparison of multiple sedation strategies simultaneously, giving nurses and physicians a comprehensive view of available options rather than limited head-to-head comparisons
• Understanding the comparative effectiveness and safety profiles of different pharmacological sedation approaches can help endoscopy teams develop standardized protocols and improve patient outcomes
• The focus on therapeutic procedures addresses a critical knowledge gap, as these complex interventions present unique sedation challenges compared to routine screening colonoscopies or upper endoscopies

Clinical Relevance

This research directly impacts daily nursing practice in endoscopy units by providing evidence to support sedation protocol development and medication selection for therapeutic procedures. GI nurses are integral members of the sedation team, responsible for pre-procedure assessment, intravenous access, medication administration, and continuous patient monitoring throughout the procedure. Having comprehensive data on the comparative effectiveness of different sedation strategies enables nurses to better anticipate patient responses, prepare appropriate monitoring equipment, and collaborate more effectively with physicians in selecting the most suitable approach for individual patients.

The findings of this systematic review can inform unit-wide quality improvement initiatives and protocol standardization efforts. Endoscopy units increasingly rely on evidence-based pathways to ensure consistent, safe care delivery while optimizing efficiency and resource utilization. When therapeutic procedures require longer sedation times and potentially deeper levels of consciousness suppression, having clear guidance on optimal pharmacological approaches becomes even more critical for maintaining patient safety and procedural success rates.

From a professional development perspective, this research reinforces the importance of staying current with sedation science and pharmacology. As therapeutic endoscopy continues to evolve with new techniques like endoscopic submucosal dissection, peroral endoscopic myotomy, and complex biliary interventions, nursing expertise in advanced sedation management becomes increasingly valuable. Understanding the nuances of different sedation regimens enhances clinical judgment and supports the expanding scope of practice for experienced GI nurses working in high-acuity endoscopy environments.

Bottom Line

This systematic review and network meta-analysis provides GI nurses with crucial evidence-based insights into optimal sedation strategies for therapeutic endoscopic procedures, directly supporting safer patient care, more informed clinical decision-making, and the development of standardized protocols that can improve both patient outcomes and unit efficiency in increasingly complex procedural environments.