Current and Emerging Sedation Practices for Colonoscopy: A Narrative Review of Pharmacological Agents, High-Risk Populations, and Safety Considerations

Colonoscopy is the gold standard for colorectal cancer screening and diagnosis of gastrointestinal disorders, yet the procedure can still provoke anxiety and pain in many patients. Advances in anesthesia and sedation techniques have significantly improved patient tolerance while maintaining procedural efficiency and safety. This review explores the physiological mechanisms of pain during colonoscopy, compares anesthetic and sedative agents—including newer drugs like remimazolam and dexmedetomidine—and evaluates emerging evidence from recent studies on sedation efficacy, safety, and patient outcomes. Special attention is given to high-risk patient populations, including those with obesity, obstructive sleep apnea, cardiovascular diseases, respiratory disorders and frailty syndrome. Propofol-based sedation remains the most commonly used agent for deep sedation. However, newer pharmacological agents with enhanced pharmacokinetic properties and improved safety profiles are increasingly influencing contemporary anesthesia practices. An individualized approach to sedation is essential. Incorporating current evidence into clinical decision-making optimizes both patient experience and procedural outcomes.