Procedural Sedation by Nonanesthesia Providers

2011 ◽  
pp. 49-61 ◽  
Author(s):  
Julia Metzner ◽  
Karen B. Domino
Keyword(s):  
Health Care Providers ◽  
Improve Patient Safety ◽  
Essential Elements ◽  
Procedural Sedation ◽  
Certified Registered Nurse Anesthetists ◽  
The Face ◽  
Sedation And Analgesia ◽  
American Society ◽  
Gi Radiology ◽  
American Society Of Anesthesiologists

Although anesthesiologists and certified registered nurse anesthetists (CRNAs) are experts in sedation/analgesia outside of the operating room (OOOR), extensive demand in the face of limited resources has resulted in sedation being routinely performed by nonanesthesia health care providers. Sedation/analgesia is administered for minor office and hospital procedures in a variety of areas, including gastroenterology (GI), radiology, cardiology, dentistry, and the emergency room. Given the extreme diversity of settings, it is understandable that procedural sedation and analgesia evolved to meet the unique needs of each of these specialties. However, to improve patient safety, the Joint Commission and the American Society of Anesthesiologists (ASA) issued standards that unify and standardize the various approaches across specialties and institutions.1 , 2 This chapter will briefly review the essential elements needed to develop a safe policy for sedation by nonanesthesia practitioners.

Procedural Sedation by Nonanesthesia Providers

2018 ◽  
Author(s):  
Julia Metzner ◽  
Karen B. Domino
Keyword(s):  
Health Care Providers ◽  
Essential Elements ◽  
Nurse Anesthetists ◽  
Procedural Sedation ◽  
Care Providers ◽  
Standard Equipment ◽  
Certified Registered Nurse Anesthetists ◽  
The Face ◽  
Risk Patients ◽  
Patient Preparation

Although anesthesiologists and certified registered nurse anesthetists are experts in sedation/analgesia outside of the operating room, extensive demand in the face of limited resources has resulted in sedation being routinely performed by nonanesthesia health care providers. Safe administration of procedural sedation/analgesia by nonanesthesia professionals requires an understanding of the continuum of sedation/general anesthesia; extensive training and credentialing of personnel performing sedation; appropriate patient preparation and selection, with an anesthesia consult for higher-risk patients; adherence to fasting guidelines, standard equipment, and monitoring procedures; and a thorough knowledge of the pharmacologic and physiologic properties of sedative and analgesic drugs. This chapter briefly reviews the essential elements needed to develop a safe policy for sedation by nonanesthesia practitioners.

scholarly journals Procedural Sedation and Analgesia in Adults - new trends in patients safety

2019 ◽  
Vol 2 (1) ◽  
pp. 11-22
Author(s):  
Mădălina Duţu ◽  
Robert Ivascu ◽  
Darius Morlova ◽  
Alina Stanca ◽  
Dan Corneci ◽  
...  
Keyword(s):  
Patient Monitoring ◽  
Diagnostic Procedures ◽  
Procedural Sedation ◽  
Anesthesia Care ◽  
Monitored Anesthesia Care ◽  
Moderate Sedation ◽  
Procedural Sedation And Analgesia ◽  
Sedation And Analgesia ◽  
American Society ◽  
American Society Of Anesthesiologists

AbstractSedation and analgesia may be needed for many interventional or diagnostic procedures, whose number has grown exponentially lately. The American Society of Anesthesiologists introduced the term “procedural sedation and analgesia” (PSA) and clarified the terminology, moderate sedation and Monitored Anesthesia Care. This review tries to present a nondissociative sedation classification, follow ing ASA guidelines as well as pre-procedural assessment and preparation, in order to choose the appropriate type and level of sedation, patient monitoring and agents, which are most commonly used for sedation and/or analgesia, along with their possible side effects. The paper also lists the possible complications associated with PSA and a few specific particularities of procedural sedation.

scholarly journals Efficacy and Safety of Pediatric Procedural Sedation Outside the Operating Room

2020 ◽  
Vol 10 (4) ◽  
Author(s):  
Thitima Sirimontakan ◽  
Ninuma Artprom ◽  
Nattachai Anantasit
Keyword(s):  
Adverse Events ◽  
Operating Room ◽  
Demographic Data ◽  
Procedural Sedation ◽  
Efficacy And Safety ◽  
Serious Adverse Events ◽  
Physical Status Classification ◽  
Sedation And Analgesia ◽  
American Society ◽  
American Society Of Anesthesiologists

Background: The volume of pediatric Procedural Sedation and Analgesia (PSA) outside the operating room has been increasing. This high clinical demand leads non-anesthesiologists, especially pediatric intensivists, pediatricians, and emergency physicians, to take a role in performing procedural sedation. Our department has established the PSA service by pediatric intensivists since 2015. Objectives: We aimed to assess the efficacy and safety of PSA outside the operating room conducted by pediatric intensivists and identify risk factors for severe adverse events. Methods: This was a retrospective descriptive study conducted from January 2015 to July 2019. Children aged less than 20 years who underwent procedural sedation were included. We collected demographic data, sedative and analgesic medications, American Society of Anesthesiologists (ASA) Physical Status Classification, indications for sedation, the success of procedural sedation, and any adverse events. Results: Altogether, 395 patients with 561 procedural sedation cases were included. The median age was 55 months (range: 15 to 119 months), and 58.5% (231/395) were male. The rate of successful procedures under PSA was 99.3%. Serious Adverse Events (SAE) occurred in 2.7%. Patients who received more than three sedative medications had higher SAE than patients who received fewer medications (adjusted for age, location of sedation, type of procedure, and ASA classification) (odds ratio: 8.043; 95% CI: 2.472 - 26.173, P = 0.001). Conclusions: Our data suggest that children who undergo procedural sedation outside the operating room conducted by pediatric intensivists are safe and effectively treated. Receiving more than three sedative medications is the independent risk factor associated with serious adverse events.

Society Guidelines

2018 ◽  
pp. 382-391
Author(s):  
Urmila Tirodker
Keyword(s):  
Procedural Sedation ◽  
Advanced Practice ◽  
Patient Evaluation ◽  
Procedural Sedation And Analgesia ◽  
American Academy Of Pediatrics ◽  
Enhance Patient Safety ◽  
Sedation And Analgesia ◽  
American Society ◽  
Guidelines And Standards ◽  
American Society Of Anesthesiologists

In the past several decades the practice of procedural sedation and analgesia has evolved into a distinct skill set and a service that has rapidly grown in terms of indications, need, practitioner types, and practice settings. The scope of non-anesthesiology sedation providers includes but is not limited to intensivists, emergency medicine physicians, hospitalists, dentists, gastroenterologists, pulmonologists, cardiologists, advanced practice providers, and nursing. Several subspecialty societies and regulatory institutions have published and revised guidelines and standards to enhance patient safety by standardizing various aspects related to patient evaluation, personnel, monitoring, and management of procedural sedation and analgesia and its recovery. The American Academy of Pediatrics, American Society of Anesthesiologists, and the American College of Emergency Physicians are the groups that have published the most widely disseminated, comprehensive guidelines. This chapter gives an overview of these societies’ guidelines.

scholarly journals Respiratory Monitoring: Physiological and Technical Considerations

2009 ◽  
Vol 56 (1) ◽  
pp. 14-22 ◽  
Author(s):  
Daniel E. Becker ◽  
Andrew B. Casabianca
Keyword(s):  
Continuing Education ◽  
Respiratory Function ◽  
Negative Impact ◽  
Technical Issue ◽  
Anatomy And Physiology ◽  
Sedation And Analgesia ◽  
Per Se ◽  
American Society ◽  
American Society Of Anesthesiologists ◽  
Technical Considerations

Abstract The American Dental Association and several dental specialty organizations have published guidelines that detail requirements for monitoring patients during various levels of sedation and, in some cases, general anesthesia. In general, all these are consistent with those guidelines suggested by the American Society of Anesthesiologists for sedation and analgesia by nonanesthesiologists. It is well accepted that the principal negative impact of sedation and anesthesia is the compromise of respiratory function. While monitoring per se is a technical issue, an appreciation of its purpose and the interpretation of the information provided require an understanding of respiratory anatomy and physiology. The focus of this continuing education article is to address the physiological aspects of respiration and to understand the appropriate use of monitors, including the interpretation of the information they provide.

Pediatric Procedural Sedation

2017 ◽  
Author(s):  
Sara W. Nelson ◽  
J. Calvin Simmons
Keyword(s):  
Emergency Department ◽  
Pediatric Population ◽  
Parent Satisfaction ◽  
Well Being ◽  
Procedural Sedation ◽  
Negative Consequences ◽  
Efficient Manner ◽  
Procedural Sedation And Analgesia ◽  
Sedation And Analgesia ◽  
American Society

Children present to the emergency department with painful conditions or conditions that require diagnostic or therapeutic procedures every day. As emergency physicians, we need to have the skills to manage our patients’ pain and anxiety in a safe and efficient manner. Appropriately managing pain and anxiety facilitates medical interventions, decreases patients’ suffering, improves patient and parent satisfaction, and improves the quality of care. Conversely, failure to adequately provide analgesia and sedation can have negative consequences for pediatric patients. In the pediatric population, inadequate pain control not only causes immediate harm and fear but can also worsen the reaction to future medical care and potentially affect the child’s long-term psychological well-being. This review provides an overview of pediatric procedural sedation, as well as the pathophysiology and practice. Figures show the sedation continuum with associated physiologic responses, oxyhemoglobin desaturation during apnea for various types of patients, and examples of capnography waveforms in procedural sedation and analgesia (PSA). Tables list potential indications for pediatric PSA in the emergency department, American Society of Anesthesiologists’ classifications, drugs and pharmacokinetics of common agents used in PSA, focused history and physical examination for patients undergoing PSA, SOAPME (Suction, Oxygen, Airway, Pharmacy, Monitors, Equipment) acronym for PSA equipment, and suggested monitoring for PSA pre- and postprocedure. This review contains 3 highly rendered figures, 6 tables, and 41 references. Key words: pediatric analgesia; pediatric pain; pediatric procedural sedation; pediatric sedation; procedural pain relief; procedural sedation and analgesia

A cross-sectional overview of the second 4000 incidents reported to webAIRS, a de-identified web-based anaesthesia incident reporting system in Australia and New Zealand

2021 ◽  
Vol 49 (6) ◽  
pp. 422-429
Author(s):  
Neville M Gibbs ◽  
Martin D Culwick ◽  
Yasmin Endlich ◽  
Alan F Merry
Keyword(s):  
Improve Patient Safety ◽  
Similar Rate ◽  
Time Of Day ◽  
Cross Sectional ◽  
Web Based ◽  
High Dependency ◽  
Inhalational Anaesthesia ◽  
American Society ◽  
Anaesthesia Care ◽  
American Society Of Anesthesiologists

This cross-sectional overview of the second 4000 incidents reported to webAIRS has findings that are very similar to the previous overview of the first 4000 incidents. The distribution of patient age, body mass index and American Society of Anesthesiologists physical status was similar, as was anaesthetist gender, grade, location and time of day of incidents. About 35% of incidents occurred during non-elective procedures (vs. 33% in the first 4000 incidents). The proportion of incidents in the various main categories was also similar, with respiratory/airway being most common, followed by cardiovascular, medication-related and medical device or equipment-related incidents. Together these categories made up about 78% of all incidents in both overviews. The immediate outcome was comparable with reports of harm in about a quarter of incidents and a similar rate of deaths (4.7% vs. 4.2%). However, the proportion of patients who had received total intravenous anaesthesia was higher (17.6% vs. 7.7%) and the proportion of patients who received combined intravenous and inhalational anaesthesia was lower (52.3% vs. 58.4%), as was the proportion receiving local anaesthesia alone (1.6% vs. 6.7%). There was a small increase in the number of incidents resulting in unplanned admission to a high dependency or intensive care unit (18.1% vs. 13.5%). It is not clear whether these differences represent trends or random observations. About 48% of incidents were considered preventable by the reporters (vs. 52% in the first 4000). These findings support continued emphasis on human and system factors to promote and improve patient safety in anaesthesia care.

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