Understanding Anesthesia for an Upper Endoscopy
- Jen Overton
- Nov 13, 2025
- 7 min read
If you’re preparing for an upper endoscopy, also known as an esophagogastroduodenoscopy (EGD), you may be curious or a bit anxious about the anesthesia process. As a nurse anesthetist with 20 years of experience, I’m here to guide you through what to expect on the day of your procedure. My goal is to ease your concerns by explaining the anesthesia used, why it’s chosen, and how it will feel, so you can approach your endoscopy with confidence.
An upper endoscopy is a common procedure that allows your doctor to examine the lining of your esophagus, stomach, and upper small intestine (duodenum) to diagnose or treat conditions like heartburn, swallowing difficulties, persistent unexplained nausea, non-cardiac chest pain or abdominal pain.
While you’ve likely discussed the procedure with your gastroenterologist, the anesthesia part might feel unfamiliar since you typically meet your anesthesia team only on the day of the procedure. Let’s break it down together to make it less intimidating.
What Type of Anesthesia Is Used for an Upper Endoscopy?
The standard anesthesia method for an upper endoscopy is monitored anesthesia care (MAC), also known as IV sedation or “twilight anesthesia.” In rare cases, general anesthesia may be used for complex situations or specific medical needs. Below, I’ll focus on MAC, as it’s the most common approach, and briefly cover general anesthesia, explaining what you can expect during the process.
Monitored Anesthesia Care (MAC): The Standard Approach
Purpose:
MAC involves IV sedation to keep you relaxed, comfortable, and drowsy during the endoscopy. It ensures you feel no discomfort and often have little to no memory of the procedure, while allowing you to breathe on your own and recover quickly. This is ideal for an upper endoscopy, which typically lasts 5–20 minutes and is performed in an outpatient setting.
The Process:
Before the Procedure: You’ll arrive at the hospital or endoscopy center, check in, and change into a gown. A nurse will take your vital signs and place an IV in your arm or hand to deliver fluids and sedation medications.
In the preoperative area, you’ll meet your anesthesia provider (a nurse anesthetist, like me, or anesthesiologist), who will review your medical history, discuss any concerns, and confirm the anesthesia plan.
In the Procedure Room: You’ll be wheeled into the procedure room on a stretcher. The room may feel cool and busy as the team prepares equipment, but we’ll keep you comfortable with warm blankets. Monitors will be placed to track your heart rate, blood pressure, and oxygen levels.
In some cases, before sedation, your throat may be sprayed with a local anesthetic numbing medicine.
During MAC: Once you’re positioned (usually on your left side), a hard circular plastic device will be placed in your mouth. This is called a bite block and it ensures that your mouth stays open throughout the procedure. We can't do the procedure with your mouth closed, of course!
After the bite block is placed, your anesthesia provider will administer sedation medications through your IV, such as propofol or midazolam. These medicines help you drift into a light sleep-like state. You’ll breathe on your own, and no breathing tube is typically needed. The gastroenterologist will perform the endoscopy while we monitor you closely to ensure your safety and comfort.
After the Procedure: Once the endoscopy is complete, the sedation is stopped, and you’ll wake up quickly. You’ll be moved to the recovery area, where a nurse will monitor you until you’re fully alert and ready to go home, usually within 30 minutes to 1 hour, in the case of outpatient procedures.
What It Feels Like:
The IV placement may feel like a quick pinch. The throat spray, if used, tastes slightly bitter and causes a numb sensation in your throat, which might feel unusual but not painful. As the sedation begins, you’ll feel a pleasant wave of relaxation, possibly with a cool sensation in your IV.
During MAC, you’ll be in a twilight state—drowsy and unaware of the procedure. Many patients remember nothing at all, though some recall vague sensations, like mild pressure or the sound of voices, but no pain.
In recovery, you may feel slightly groggy or have a mild sore throat from the endoscope, which we’ll manage with fluids.
Wondering How Many Times Is It Safe to Have Anesthesia? Click the image below to find out!
General Anesthesia: For Rare Cases
Purpose:
General anesthesia, which puts you fully asleep, is rarely used for upper endoscopies but may be necessary for patients with specific medical conditions (e.g., acute upper GI bleed, food bolus, specific patient factors that make MAC anesthesia too difficult or unsafe, or complex procedures requiring longer duration). It ensures you’re completely unconscious and unaware during the procedure.
The Process:
Before the Procedure: Your anesthesia provider will explain why general anesthesia is needed and review your medical history. An IV will be placed for medications and fluids.
During the Procedure: In the procedure room, you’ll receive IV medications to fall asleep quickly. A breathing tube or airway device may be used to help you breathe, placed after you’re unconscious. We’ll monitor you closely throughout.
After the Procedure: As the procedure ends, the anesthesia is stopped, and you’ll wake up in the recovery area after the airway device is removed. You may feel groggy or slightly confused initially but will recover within about an hour.
What It Feels Like:
Going under general anesthesia feels like drifting off to sleep, with a cool sensation in your IV. You won’t feel or remember the procedure. Waking up may feel like emerging from a deep nap, with possible grogginess or a sore throat from the airway device or endoscope, which we’ll manage with fluids.
Local Anesthesia: A Minor Component
For upper endoscopies, a local anesthetic spray is sometimes applied to the throat to reduce gagging when the endoscope is inserted. This isn’t the primary method of pain control, as MAC (sedation) handles discomfort and keeps you unaware, but it can complement sedation by making the procedure smoother. The spray is quick and causes temporary numbness in the throat.
Having a colonoscopy at the same time? Spoiler alert- the anesthesia is the same for both! But if you want to read an article about colonoscopy anyway just to calm your nerves, click the image below to read What to Expect From Anesthesia at Your Colonoscopy.
What to Expect on the Day of Your Upper Endoscopy
Understanding the flow of the day can help calm your nerves, so here’s a step-by-step overview:
Arrival at the Facility: You’ll check in at the hospital or endoscopy center, change into a gown, and have your vital signs checked. A nurse will start an IV and review your preparation (e.g., fasting instructions, medications, etc).
Meeting Your Anesthesia Team: Your anesthesia provider will introduce themselves, explain the sedation plan, and answer any questions. This is a great time to share concerns, like past reactions to sedation.
Going to the Procedure Room: You’ll be wheeled into the procedure room on a stretcher. The team will position you comfortably, usually on your left side, and apply monitors. If a throat spray is used, it will be applied now.
Receiving MAC: Sedation is administered through your IV, and you’ll drift into a relaxed, drowsy state. The gastroenterologist will perform the endoscopy, which typically takes 5–20 minutes.
Recovery Area: After the procedure, you’ll wake up in the recovery area. Nurses will monitor you, manage any minor discomfort (like a sore throat or bloating), and ensure you’re ready to go home. You’ll need someone to drive you home due to the sedation.
Why You Don’t Need to Worry
It’s natural to feel anxious about anesthesia, especially since an upper endoscopy is often a diagnostic procedure rather than a treatment you’ve planned for a long time. Rest assured, MAC is a safe, widely used method for endoscopies, designed to keep you comfortable with minimal side effects. Your anesthesia team is highly trained, using advanced monitoring to ensure your safety throughout the procedure. Upper endoscopies are quick, and the sedation allows you to recover rapidly and return home the same day.
Here are a few tips to prepare mentally:
Ask Questions: Share any concerns with your anesthesia provider, such as worries about sedation or waking up during the procedure (which is extremely rare with MAC).
Focus on the Benefits: An upper endoscopy helps diagnose or treat digestive issues, and anesthesia ensures you’re comfortable during this brief process.
Trust Your Team: Your anesthesia provider and gastroenterologist work together to make the procedure smooth and safe, staying with you the entire time.
Still worried about the idea of being put to sleep? That's ok. Let's keep learning. Click the image below to read How to Overcome the Fear of Anesthesia: Tips for a Better Surgery Experience.
Final Thoughts
Anesthesia for an upper endoscopy, typically through monitored anesthesia care (MAC), is designed to keep you relaxed, comfortable, and pain-free during this quick, important procedure. With MAC, you’ll drift into a twilight state, unaware of the process, and wake up feeling refreshed. General anesthesia, while rare, is a safe alternative for specific cases.
By understanding what to expect, you can approach your endoscopy with less anxiety and more confidence, knowing it’s a vital step in maintaining your health. If you have questions before your procedure, don’t hesitate to reach out to your healthcare team—we’re here to support you. Feel free to leave a question or comment below if you want to connect.
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**Information provided is intended as general healthcare information for the public and should be used as a guide. This information should not be substituted for the specific personal advice recommended by your own healthcare team who are familiar with your specific health history.*
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