Significance of the American Society of Anesthesiologists’ Procedural Sedation and Analgesia Guideline 2018 for Future of Moderate Sedation Education

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.

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

Central European Journal of Clinical Research ◽

10.2478/cejcr-2018-0012 ◽

2018 ◽

Vol 0 (0) ◽

Author(s):

Mădălina Duţu ◽

Robert Ivascu ◽

Darius Morlova ◽

Alina Stanca ◽

Dan Corneci ◽

...

Keyword(s):

Side Effects ◽

Procedural Sedation ◽

Moderate Sedation ◽

Procedural Sedation And Analgesia ◽

Sedation And Analgesia ◽

American Society

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, following 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.

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Society Guidelines

The Pediatric Procedural Sedation Handbook ◽

10.1093/med/9780190659110.003.0056 ◽

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.

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Pediatric Procedural Sedation

10.2310/em.4409 ◽

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

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Procedural Sedation by Nonanesthesia Providers

Anesthesia Outside of the Operating Room ◽

10.1093/med/9780195396676.003.0007 ◽

2011 ◽

pp. 49-61 ◽

Cited By ~ 1

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.

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Efficacy and Safety of Pediatric Procedural Sedation Outside the Operating Room

Anesthesiology and Pain Medicine ◽

10.5812/aapm.106493 ◽

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.

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