Monitoring the Depth of Sedation During Gastrointestinal Endoscopy: A Narrative Review of Current Evidence and Clinical Recommendations

Sedation and anesthesia are integral components of modern gastrointestinal endoscopy, enhancing patient comfort and procedural success while adding risks such as respiratory and cardiovascular complications. Accurate monitoring of sedation depth is essential to balance safety and procedural efficacy. This narrative literature review synthesizes current evidence on monitoring depth of anesthesia during endoscopic procedures, including clinical assessment scales, capnography, and processed electroencephalogram (pEEG)-based technologies. The effects of commonly used sedative agents on monitoring parameters and the impact of different monitoring strategies on clinical outcomes are also discussed. Current evidence indicates that clinical assessment remains the cornerstone of monitoring during moderate sedation, while capnography improves early detection of respiratory compromise during deep sedation. pEEG-based monitoring may provide additional value in selected high-risk or prolonged procedures but should complement, not replace, clinical evaluation. A multimodal monitoring approach tailored to sedation depth and patient risk profile is likely to be the most effective strategy for optimizing patient safety. Future research should focus on standardizing monitoring protocols and identifying populations most likely to benefit from advanced monitoring techniques.