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Letters |

Anesthesia Care for Low-Risk Patients Undergoing Gastrointestinal Endoscopies

James Nielsen, MBBS, FANZCA
JAMA. 2012;307(24):2585-2587. doi:10.1001/jama.2012.6533.
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To the Editor: Dr Liu and colleagues1 demonstrated wide variation in the use of specialist anesthesia staff to provide sedation for endoscopy. They also estimated that 65% to 85% of endoscopy patients are low risk and inferred that “a substantial share of the spending for gastroenterology anesthesia may be considered potentially discretionary.”

However, important detail necessary to study that hypothesis is missing from their data. First, there is no comparison of safety or complications between the 2 patient cohorts. Second, there is no comparison of patient comfort or satisfaction. Third, there is no information about the relative efficiency of the 2 procedure cohorts (measured both by time taken for procedures and by capacity to visualize the entire bowel and detect and treat disease found). The authors have described variation in sedation practice but not equivalence of quality of practice. Endoscopist-supervised sedation may happen frequently but that does not make it equivalent.

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June 27, 2012
Pascal Scemama, MD, MBA; Brian Lee, MD; Emily Guimaraes, MD
JAMA. 2012;307(24):2585-2587. doi:10.1001/jama.2012.6539.
June 27, 2012
Douglas K. Rex, MD
JAMA. 2012;307(24):2585-2587. doi:10.1001/jama.2012.6535.
June 27, 2012
Azriel Perel, MD
JAMA. 2012;307(24):2585-2587. doi:10.1001/jama.2012.6537.
June 27, 2012
Hangsheng Liu, PhD; Soeren Mattke, MD, DSc
JAMA. 2012;307(24):2585-2587. doi:10.1001/jama.2012.6541.
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