New modalities and paradigms for sedation: “new sedation agents”

Most endoscopic procedures in the USA are performed with some form of conscious sedation. The typical practice of midazolam and fentanyl is being supplanted by newer agents, including propofol, fospropofol, ketamine, and dexmedetomidine. These agents offer various advantages; propofol has significantly faster onset and offset, fospropofol avoids the problems associated with the lipid emulsion of propofol, and ketamine and dexmedetomidine avoid the respiratory depression associated with other sedatives. Understanding the properties of these agents may improve patient outcomes during endoscopy.