Patients should have ongoing treatment to correct electrolyte disturbances throughout the perioperative period.Level of evidence: Moderate；Recommendation grade: Strong

Balanced crystalloids should be used in preference to 0.9% normal saline for resuscitation and to maintain intravascular volume.Level of evidence: Low；Recommendation grade: Weak

Use of arterial lines and/or central venous pressure catheters should be considered at an early stage to aid in physiological assessment and to deliver and titrate vasopressors and fluid therapy.Level of evidence: Moderate；Recommendation grade: Strong

GDHT should be considered during surgery in high-risk patients to optimize cardiac index. A MAP of 60–65 mmHg and Cardiac Index [2.2 L/min/m2 individualized to the patient, should be maintained during surgery using appropriate vasopressors and inotropes as needed. Level of evidence: Moderate；Recommendation grade: Strong

Patients should have their glucose closely monitored and controlled in the range of 7.7–10 mmol/l, preferably with the use of a variable rate insulin infusion. Level of evidence: Moderate；Recommendation grade: Strong.

Transfusion of red blood cells should be restrictive (trigger Hb 70 -90 g/l), with exceptions based on individualized clinical status and comorbidities. Level of evidence: Moderate；Recommendation grade: Strong.

Each patient should be assessed for the optimal perioperative analgesic regimen, considering the presence of sepsis and coagulation abnormalities. Multimodal management should include acetaminophen and non-steroidal anti-inflammatory drugs if there are no contraindications.Level of Evidence: Low；Recommendation: Strong

We recommend that in patients with cognitive impairment and/or learning disability, an assessment of capacity is carried out to inform the discussion around choice of sedation.（Evidence level: Very Low；Recommendation grade:Strong).

We recommend that if during a sedated endoscopy, the patient appears to be tolerating the procedure poorly, the endoscopist should stop the procedure (if safe to do so) in order to assess the patient’s wishes and decide if the procedure should be abandoned and alternatives arranged.（Evidence level: Very Low；Recommendation grade:Strong).

We recommend that a minimum of two appropriately trained endoscopy assistants are required for endoscopic procedures in which sedation has been administered.（Evidence level: Very Low；Recommendation grade:Strong).