Sedation and Analgesia for Diagnostic and Interventional Medical, Dental, or Surgical Procedures
Definitions:
- Procedural sedation and analgesia
Drug-induced tolerance of uncomfortable or painful procedure.- May include lack of memory
- Does not necessarily include lack of response to painful stimulation
- Conscious sedation
Drug-induced depression of consciousness, in which patients are able to response purposefully to commands or light tactile stimulation.- Airway or cardiorespiratory support should only rarely be required
- Deep sedation
Drug-induced depression of consciousness that readily progresses to the poijnt where consciousness is lost, and patients respond only to painful stimulation. - Analgesia
Reduction or elimination of pain perception. - General anaesthesia
Drug-induced state characterised by:- Absence of purposeful response to any stimulus
- Loss of protective airway reflexes
- Depression of respiration
- Disturbance of circulatory reflexes
Aims of sedation:
- Enhance patient comfort whilst facilitating the procedure
- Range of options may be required
Options exist on a continuum and are not discrete stages. - Must be prepared to manage:
- Loss of airway patency
- Respiratory depression
- Cardiovascular depression
- Adverse drug reactions
Requirements of sedation:
- Adequate pre-anaesthetic consultation
Aiming to identify patients at ↑ risk of airway or cardiorespiratory compromise. - Facilities
- Room to perform resuscitation
- Appropriate lighting
- Equipment
- Suction source
- Oxygen source
- Bag-Mask Ventilator
- Airway equipment
- Resuscitation drugs
- Monitoring
Including ETCO2. - Access to ECG and defibrillator
- Oxygen
100% oxygen if anaesthetic gases are used.
- Training
- Minimum of three months full time equivalent of supervised training in procedural sedation or anaesthesia
- Documentation
- Recovery