Gastrointestinal endoscopy has evolved rapidly over the past 30 years and has become one of the larger specialties in medicine. An increasing number of diagnostic and therapeutic procedures are being performed with the aid of the flexible endoscope. With this expansion in the use of endoscopy came the routine administration of premedication. The endoscopist thus became a part-time anaesthetist. The lack of proper studies to evaluate the untoward effects of diazepam and, later, midazolam, at their introduction led to an unfortunate increase in reports of fatalities after the introduction of midazolam. Later studies showed the safety of these agents when properly administered, but the affair served to focus attention on monitoring in gastrointestinal endoscopy. The benefits of using extracorporeal monitoring equipment during endoscopy has not been proved in clinical trials, and because of this those bodies that issue guidelines on medical practice, such as the American Society for Gastrointestinal Endoscopy, have not mandated the use of these devices. The guidelines issued have emphasized the importance of training and recertification in advanced cardiac life support. Many endoscopists are reluctant to recognized their role as anaesthetist, and to adopt new practices recommended in the guidelines. However, these changes represent the evolution of medicine and reflect the desire to ensure a uniform high quality of care and as such should not be resisted.
