Gastrointestinal endoscopy can be divided into common methods and painless methods. General examination refers to gastroscopy or colonoscopy when the patient is awake. Because the examination operation will cause discomfort such as pharyngeal reflex and intestinal wall traction pain, more and more patients will choose painless gastrointestinal endoscopy. Painless gastrointestinal endoscopy is a diagnostic and therapeutic method for anesthesiologists to use sedative and analgesic drugs for gastrointestinal endoscopy when patients are unconscious. Such patients will use a lot of anesthetic drugs, including propofol, midazolam, remifentanil and so on. Their main pharmacological effects are hypnosis, sedation and analgesia. The purpose is to eliminate or alleviate the discomfort of patients such as pain and anxiety during examination, and improve patients' acceptance and satisfaction with digestive endoscopy. At the same time, it can make the endoscopist complete the diagnosis and treatment process more smoothly, reduce the risk of intraoperative injury, and provide opportunities for the diagnosis and treatment of digestive tract diseases.

1) voluntarily accepted painless endoscopic diagnosis and treatment; 2) Patients who are sensitive, fearful, excessively anxious and unable to cooperate with such examinations; 3) Long and complicated endoscopic examination and treatment; 4) The general condition is good, and the American Anesthesiology Association's physiological status is classified as ASA Ⅰ-Ⅱ; 5) Children or babies who can't cooperate.

1) contraindication of routine endoscopic surgery; 2) asa ⅴ patients; 3) Patients with severe heart disease, such as cyanotic heart disease, congenital heart disease with pulmonary hypertension, malignant arrhythmia, and heart function grade 3-4. 4) Difficult airway and severe respiratory diseases (obstructive sleep apnea syndrome, mouth opening disorder, limited neck or jaw movement, morbid obesity, acute respiratory infection, acute attack of chronic obstructive pulmonary disease, asthma out of control, etc. ); 5) Poor liver function, acute upper gastrointestinal bleeding with shock, severe anemia, obstruction of gastroduodenal outflow tract with content retention; 6) Patients with severe nervous system diseases (such as acute stroke, convulsion and epilepsy not effectively controlled); 7) Not accompanied by a guardian; 8) Those who have a history of drug abuse and are allergic to sedatives and other anesthesia risks. For the multiple operations mentioned by the subject, it is necessary to specifically evaluate the type, location and size of the operations. For example, gastrointestinal surgery has changed the normal anatomical structure, and it is necessary to inform the attending doctor in advance. Anesthesia outpatient evaluation is needed before anesthesia for other operations.

Evaluation and interview before anesthesia: Before painless gastrointestinal endoscopy anesthesia, anesthesiologists need to do a good job of interview before anesthesia. First, they should inform the patient of the informed consent form, inform the patient of the operation process of sedation anesthesia, explain the purpose and risk of anesthesia, obtain the consent of the patient and guardian, and sign the informed consent form. The purpose of pre-anesthesia evaluation is to fully understand the patient's medical history and related examination results, judge whether the patient meets the conditions of painless anesthesia, and ask whether the patient has reached the prescribed drinking and fasting time and whether he has a denture.

Complete the preparatory work: check whether the anesthesia machine, oxygen and monitor can work normally, establish a vein channel for the patient to facilitate the injection of anesthetic, connect the monitoring equipment such as blood pressure, pulse oxygen saturation probe and electrocardiogram for the patient, and wear an oxygen tube at the nose.

Monitoring during anesthesia: During anesthesia, patients will suffer from hypoxia, hypotension and limb movements. It needs the anesthesiologist to find and deal with it in time. For example, when patients inhale secretions and vomit by mistake, they need to be treated by oral inhalation in time; When patients have hypoxemia, especially obese patients, it is necessary to deliver oxygen to the mask under pressure; When patients have low blood pressure, it is necessary to speed up fluid replacement and use pressor drugs reasonably.

Post-anesthesia monitoring: patients who are not awake or awake after anesthesia but are not satisfied with the recovery of muscle tension enter the anesthesia recovery room, and their blood pressure, heart rate, breathing, oxygen saturation and mental state are monitored by full-time anesthesiologists until the patients are awake, their vital signs are stable and they can leave without special discomfort. You need a guardian to accompany you when you leave. Driving, aerial work and other activities are prohibited.