TY - CHAP M1 - Book, Section TI - Practice Guidelines for Sedation and Analgesia by Non-Anesthesiologists: An Updated Report by the American Society of Anesthesiologists Task Force on Sedation and Analgesia by Non-Anesthesiologists A1 - Bailin, Michael A1 - Spanakis, Spiro PY - 2000 T2 - Guidelines AB - |PrintPractice Guidelines for Sedation and Analgesia by Non-AnesthesiologistsComments by Spiro Spanakis, DOPre-SedationIntra-SedationPost-SedationPatientMedical history including previous experience with sedation or analgesiaFocused physical exam including vital signs, heart and lung examDetailed airway exam Follow ASA guidelines for peri-operative fastingRisks and benefits explained and understoodLaboratory testing as belowThe patient should always be in a monitored settingThe level of consciousness should be assessed and regularly re-assessedMonitor patient as described belowCertain patients (those with morbid obesity, sleep apnea, difficult airway, and others) present increased risk of complications especially with deeper levels of sedationEstablished discharge criteria should be met before release from monitored areaIntravenous access should be maintained until risk of post-procedure adverse outcome is minimalHigh-risk patients may benefit from consultation with specialist to decrease risk of cardiorespiratory depression after discharge PersonnelUnderstand pharmacology of agents used Able to recognize complicationsCapable of establishing airway and positive pressure ventilationModerate sedation: ACLS skills available within 5 minutesDeep sedation: ACLS skills within procedure roomDesignated individual to monitor patient other than individual performing procedureModerate sedation: Monitoring individual may perform minor, interruptible tasksDeep sedation: Monitoring individual should have no other responsibilitiesHigh risk patients may benefit from availability of medical specialistAppropriately trained staff should monitor patientStaff should be immediately available to manage post-procedural complicationsAbility to start intravenous access and manage airwayMonitoringBlood pressure, heart rate, oxygen saturation assessed prior to initiation of sedation Laboratory testing determined by underlying medical history and current treatment. Perform tests only if results may affect management and review prior to sedation.Moderate sedation: routine monitoring of patient’s verbal response or other appropriate responseDeep sedation: patient response requires profound stimulusPulse oximetry with alarmsContinuous monitoring of ventilationBlood pressure monitoring every 5 minutesElectrocardiography in deep sedation and in moderate sedation in patients with cardiac disease or dysrhythmias; consider CO2 monitoringLevel of consciousness, ventilation, oxygenation and hemodynamic variables recorded regularlyVital signs should be measured at least twice: at initial recovery and prior to dischargeOxygenation, ventilation, and circulation should be monitoredManual documentation of vital signs may improve situational awarenessPharmacologyIf propofol or methohexital is administered, individual capable of rescuing patient from general anesthesia should be available Combination of sedative and analgesic agents may be administered in small incremental doses Pharmacologic antagonists availableModerate sedation: consider supplemental oxygen Deep sedation: supplemental oxygen should be administered unless contraindicated If propofol or methohexital are administered, standards for deep sedation should be maintained Opioids and other sedatives have pharmacologic properties that may continue to depress respiratory and cardiovascular systems during recoveryPharmacologic antagonists and oxygen should be present EquipmentIntravenous access should be established and maintainedPre-procedure endotracheal intubation must be considered in patients with aspiration riskPositive pressure ventilation apparatus availableSupplemental oxygen source Resuscitative medicinesSuction availableAdvanced airway equipment availableFunctional defibrillator availableRecovery area should have appropriate resuscitation equipment present including suction, airway supplies, ACLS medications, defibrillator, bag-mask ventilation device SN - PB - The McGraw-Hill Companies, Inc. CY - New York, NY Y2 - 2024/03/29 UR - accessanesthesiology.mhmedical.com/content.aspx?aid=5010028 ER -