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

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.

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 Dexmedetomidine use during epiduroscopy reduces fentanyl use and postoperative nausea and vomiting: A single-center retrospective study

2018 ◽  
Vol 6 ◽  
pp. 205031211875680 ◽  
Author(s):  
Takashi Suzuki ◽  
Ryota Inokuchi ◽  
Kazuo Hanaoka ◽  
Machi Suka ◽  
Hiroyuki Yanagisawa
Keyword(s):  
Retrospective Study ◽  
Postoperative Nausea ◽  
Postoperative Nausea And Vomiting ◽  
Nausea And Vomiting ◽  
Anesthesia Care ◽  
Low Back ◽  
Monitored Anesthesia Care ◽  
History Of ◽  
American Society ◽  
American Society Of Anesthesiologists

Objectives: Minimally invasive epiduroscopy has recently been reported as an effective treatment procedure for chronic and intractable low back pain. However, no study has determined safe anesthetics for monitored anesthesia care during epiduroscopy. We aimed to compare and evaluate conventional monitored anesthesia care drugs with dexmedetomidine. Methods: A retrospective study including all patients who underwent epiduroscopy at the JR Tokyo General Hospital from April 2011 to March 2016 was designed. The epiduroscopy procedures were performed under anesthesia with dexmedetomidine plus fentanyl (dexmedetomidine group) or droperidol plus fentanyl (neuroleptanalgesia group). Patients who received analgesics other than fentanyl, another analgesic combined with fentanyl, any sedative other than dexmedetomidine or droperidol, or who had incomplete data were excluded. We compared (1) the type and dose of medication during the epiduroscopy and (2) the incidence of postoperative nausea and vomiting. Results: We identified 45 patients (31 and 14 in the dexmedetomidine and neuroleptanalgesia groups, respectively) with a mean age of 69.0 years. The two groups had comparable characteristics, such as age, sex, body mass index, the American Society of Anesthesiologists Physical Status, analgesics used in the clinic, comorbidities, history of smoking, and the duration of anesthesia. The dexmedetomidine group received a significantly lower fentanyl dose during surgery (126 ± 14 vs 193 ± 21 µg, mean ± standard deviation, p = 0.014) and exhibited a significantly lower incidence of postoperative nausea and vomiting (1 vs 3, p = 0.047) than the neuroleptanalgesia group. Conclusion: This study involved elderly patients, and the use of dexmedetomidine in monitored anesthesia care during epiduroscopy procedures in these patients may reduce the required fentanyl dose during surgery and the incidence of postoperative nausea and vomiting. This strategy may help prevent respiratory depression and aspiration.

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

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.

scholarly journals Analysis of urgent/emergent conversions from monitored anesthesia care to general anesthesia with airway instrumentation

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sang Kim ◽  
Brian A. Chang ◽  
Amreen Rahman ◽  
Hung-Mo Lin ◽  
Samuel DeMaria ◽  
...  
Keyword(s):  
Risk Factors ◽  
General Anesthesia ◽  
Mount Sinai Hospital ◽  
Anesthesia Care ◽  
Monitored Anesthesia Care ◽  
Surgical Specialty ◽  
Factors Associated ◽  
Physical Status Classification ◽  
American Society ◽  
American Society Of Anesthesiologists

Abstract Background Monitored Anesthesia Care (MAC) is an anesthetic service involving the titration of sedatives/analgesics to achieve varying levels of sedation while avoiding general anesthesia (GA) and airway instrumentation. The goal of our study was to determine the overall incidence of conversion from MAC to general anesthesia with airway instrumentation and elucidate reasons and risk factors for conversion. Methods In this retrospective observational study, all non-obstetric adult patients who received MAC from July 2002 to July 2015 at Mount Sinai Hospital were electronically screened for inclusion via a clinical database. Patient, procedure, anesthetic, and practitioner data were all collected and analyzed to generate descriptive analyses. Subsequent univariate and multivariate analyses were used to identify specific risk factors associated with conversion to GA. Results Overall, 0.50% (1097/219,061) of MAC cases were converted to GA. Approximately half of conversions were due to the patient’s “intolerance” of MAC (with or without failed regional anesthesia), while the other half were due to physiologic derangements. Body mass index, male sex, American Society of Anesthesiologists Physical Status Classification, anesthesia team composition, and surgical specialty were all associated with risk of conversion to GA. Conclusions This is one of the first and largest retrospective studies aimed at identifying reasons and risk factors associated with the conversion of MAC to GA. These findings may be used to help better anticipate or prevent these events.

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.

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