Be prepared
Preparing the patient and care team for procedural sedation and analgesia requires a thorough patient assessment, awareness of potential red flags, and a firm grasp of pharmacologic and reversal agents. Learn about airway management, procedural monitoring, and postsedation care in part 2 of this two-part series.
Michael Kost is director of the Frank J. Tornetta School of Anesthesia at Einstein Medical Center Montgomery/ La Salle University School of Nursing and Health Sciences in East Norriton, Pennsylvania. He’s also the director of Healthcare Simulation at Einstein Healthcare Network Philadelphia, Pennsylvania. Kost recently published Moderate Procedural Sedation and Analgesia: A Question and Answer Approach (Elsevier Science, 2020).
Selected references
American Society of Anesthesiologists Task Force on Sedation and Analgesia by Non-Anesthesiologists. Practice guidelines for sedation and analgesia by non-anesthesiologists. Anesthesiology. 2002;96(4):1004-17.
Amornyotin S. Registered nurse-administered sedation for gastrointestinal endoscopic procedure. World J Gastrointest Endosc. 2015;7(8):769-76.
Continuum of depth of sedation: Definition of general anesthesia and levels of sedation/analgesia. American Society of Anesthesiologists. 2014. asahq.org/standards-and-guidelines/continuum-of-depth-of-sedation-definition-of-general-anesthesia-and-levels-of-sedationanalgesia
Bennett CR. Conscious Sedation in Dental Practice. 2nd ed. St. Louis, MO: Mosby; 1978.
Docket No. FDA-2005-P-0059. Department of Health and Human Services, Food and Drug Administration: Center for Drug Evaluation and Research. August 11, 2010. digestivehealth.net/images/FDA-2005-P-0059-0080_1_.pdf
Farney RJ, Walker BS, Farney RM, Snow GL, Walker JM. The STOP-Bang equivalent model and prediction of severity of obstructive sleep apnea: Relation to polysomnographic measurements of the apnea/hypopnea index. J Clin Sleep Med. 2011;7(5):459–65B.
Franklin KA, Lindberg E. Obstructive sleep apnea is a common disorder in the population—A review on the epidemiology of sleep apnea. J Thorac Dis. 2015;7(8):1311-22.
Practice guidelines for moderate procedural sedation and analgesia 2018: A report by the American Society of Anesthesiologists Task Force on Moderate Procedural Sedation and Analgesia, the American Association of Oral and Maxillofacial Surgeons, American College of Radiology, American Dental Association, American Society of Dentist Anesthesiologists, and Society of Interventional Radiology. Anesthesiology. 2018:128(3):437-79.
Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: Application to healthy patients undergoing elective procedures: An updated report by the American Society of Anesthesiologists Task Force on Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration. Anesthesiology. 2017;126(3):376-93.