Procedural sedation and analgesia
| Procedural sedation and analgesia | |
|---|---|
| MeSH | D016292 |
Procedural sedation and analgesia, previously referred to as conscious sedation, is defined as "a technique of administering sedatives or dissociative agents with or without analgesics to induce a state that allows the patient to tolerate unpleasant procedures while maintaining cardiorespiratory function."[1]
Definitions
The American Society of Anesthesiologists defines the continuum of sedation as follows:[2]
| Minimal Sedation | Moderate Sedation | Deep Sedation | General Anesthesia | |
|---|---|---|---|---|
| Responsiveness | Normal to verbal stimulus | Purposeful response to verbal or tactile stimulus | Purposeful to repeated or painful stimulus | Unarousable, even to painful stimulus |
| Airway | Unaffected | No intervention required | Intervention may be required | Intervention often required |
| Ventilation | Unaffected | Adequate | May be inadequate | Frequently inadequate |
| CardioVasc Function | Unaffected | Usually maintained | Usually maintained | May be impaired |
Medical uses
This technique is often used in the emergency department for the performance of painful or uncomfortable procedures. Common purposes include:
- setting fractures
- draining abscesses
- reducing dislocations
- performing endoscopy
- for cardioversion[3]
- during various dental procedures
- during Transesophageal echocardiogram
- and certain imaging or minor procedures where the patient is unable to keep still
Agents used
Sedatives/dissociative agents
Analgesics
- Fentanyl
- Morphine
- Ketamine: Small doses of ketamine have been found to be safer than fentanyl when used in combination with propofol.[5]
Techniques
For most agents the person should have had nothing to eat for at least 6 hours. Clear fluids can be allowed up to two hours before the procedure. An exception to this may be with ketamine in children where fasting may be unnecessary.[6]
Complications
Complications depend on the sedative agent that is used. Many commonly used agents can cause respiratory depression, hypoxia and hemodynamic effects. For some agents antagonists are available that can be used to reverse the effects.
Safety
Procedural sedation can be safely performed in an emergency department if structured sedation protocols are followed.[7]
Electrocardiography, pulse oximetry, capnography and blood pressure monitoring are essential, as is the use of supplementary oxygen.
Protocols
Many institutions[who?] have protocols that are used during procedural sedation.
Controversies
![[icon]](/enwiki/wiki/File:Wiki_letter_w_cropped.svg){kind=small} | This section needs expansion. You can help by adding to it. (January 2012) |
Some resistance to sedation techniques used outside the operating room by non-anesthetists has been voiced.[8]
History
Procedural sedation used to be referred to as conscious sedation.
References
- ^ Procedural Sedation at eMedicine
- ^ "Continuum of Depth of Sedation; Definition of General Anesthesia and Levels of Sedation/Analgesia". American Society of Anesthesiologists (ASA). 2009.
- ^ "Procedural Sedation for Cardioversion".
- ^ a b Hohl, CM.; Sadatsafavi, M.; Nosyk, B.; Anis, AH. (2008). "Safety and clinical effectiveness of midazolam versus propofol for procedural sedation in the emergency department: a systematic review". Acad Emerg Med. 15 (1): 1–8. doi:10.1111/j.1553-2712.2007.00022.x. PMID 18211306.
{{cite journal}}: Unknown parameter|month=ignored (help) - ^ Messenger DW, Murray HE, Dungey PE, van Vlymen J, Sivilotti ML (2008). "Subdissociative-dose ketamine versus fentanyl for analgesia during propofol procedural sedation: a randomized clinical trial". Acad Emerg Med. 15 (10): 877–86. doi:10.1111/j.1553-2712.2008.00219.x. PMID 18754820.
{{cite journal}}: Unknown parameter|month=ignored (help)CS1 maint: multiple names: authors list (link) - ^ "BestBets: Does the time of fasting affect complication rates during ketamine sedation".
- ^ Ip U, Saincher A (2000). "Safety of pediatric procedural sedation in a Canadian emergency department". CJEM. 2 (1): 15–20. PMID 17637112.
{{cite journal}}: Unknown parameter|month=ignored (help) - ^ Krauss B, Green SM (2006). "Procedural sedation and analgesia in children". Lancet. 367 (9512): 766–80. doi:10.1016/S0140-6736(06)68230-5. PMID 16517277.
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External links
- Guidelines to Conscious (Moderate) or Procedural Sedation
- Brown TB, Lovato LM, Parker D (2005). "Procedural sedation in the acute care setting". Am Fam Physician. 71 (1): 85–90. PMID 15663030.
{{cite journal}}: Unknown parameter|month=ignored (help)CS1 maint: multiple names: authors list (link)
