Procedural sedation terminology: Moving beyond “conscious sedation”

doi:10.1067/mem.2002.122770

Annals of Emergency Medicine

Volume 39, Issue 4, April 2002, Pages 433-435

https://doi.org/10.1067/mem.2002.122770 Get rights and content

Abstract

[Green SM, Krauss B. Procedural sedation terminology: moving beyond “conscious sedation.” Ann Emerg Med. April 2002;39:433-435.]

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Cited by (59)

Sedation for Diagnostic and Therapeutic Procedures Outside the Operating Room
2019, A Practice of Anesthesia for Infants and Children
Sedation of children for tests and procedures represents a significant portion of the care that pediatric anesthesiologists provide. At the same time, other pediatric subspecialists also provide sedation services for which pediatric anesthesiologists provide back-up and oversight. The manner in which sedation is divided between anesthesiologists and other specialists is not consistent between institutions and must be decided based on patient need and the availability of individuals who are qualified to provide sedation. To aid in standardization, sedation guidelines have been promulgated by multiple organizations with the objective of bringing the same rigorous standards for evaluation, monitoring, documentation, and quality improvement to the practice of sedation that has characterized anesthesiology care. Sedation outcomes are generally improved when this care is provided in an organized system of care in which the sedation providers, administrators, nurses, and technical support have well understood protocols for scheduling cases, induction/maintenance of sedation, and recovery/discharge. The unique challenge of sedation lies in providing safe and effective service while working in a multitude of locations, each with unique challenges. Sedation providers must be aware of the requirements of each venue such as the pain and repeated procedures that characterize oncology procedures or the strong magnetic field of the MRI scanner. Care must be designed that meets the needs of the patient and the individual who is performing the procedure. In order to optimize sedation provision, an extensive knowledge of the pharmacokinetics and pharmacodynamics of the sedative and analgesic agents is critical.
Sedation for Diagnostic and Therapeutic Procedures Outside the Operating Room
2018, A Practice of Anesthesia for Infants and Children
Sedation of children for tests and procedures represents a significant portion of the care that pediatric anesthesiologists provide. At the same time, other pediatric subspecialists also provide sedation services for which pediatric anesthesiologists provide back-up and oversight. The manner in which sedation is divided between anesthesiologists and other specialists is not consistent between institutions and must be decided based on patient need and the availability of individuals who are qualified to provide sedation. To aid in standardization, sedation guidelines have been promulgated by multiple organizations with the objective of bringing the same rigorous standards for evaluation, monitoring, documentation, and quality improvement to the practice of sedation that has characterized anesthesiology care. Sedation outcomes are generally improved when this care is provided in an organized system of care in which the sedation providers, administrators, nurses, and technical support have well understood protocols for scheduling cases, induction/maintenance of sedation, and recovery/discharge. The unique challenge of sedation lies in providing safe and effective service while working in a multitude of locations, each with unique challenges. Sedation providers must be aware of the requirements of each venue such as the pain and repeated procedures that characterize oncology procedures or the strong magnetic field of the MRI scanner. Care must be designed that meets the needs of the patient and the individual who is performing the procedure. In order to optimize sedation provision, an extensive knowledge of the pharmacokinetics and pharmacodynamics of the sedative and analgesic agents is critical.
Pharmacologic Management of Patient Behavior
2016, McDonald and Avery's Dentistry for the Child and Adolescent: Tenth Edition
Procedural sedation and analgesia: Auditing the practice at Steve Biko Academic Hospital Emergency Centre from May to October 2014
2015, African Journal of Emergency Medicine
Citation Excerpt :
Procedural sedation and analgesia (PSA) is a vital skill for any physician working in an emergency centre (EC). Previously known as conscious sedation, the term PSA in now preferred.1 It is the technique of using drugs to induce a state where a patient will tolerate noxious stimuli, while maintaining his or her own cardio-respiratory function without invasive support and monitoring.2
Procedural sedation and analgesia (PSA) is a vital skill for physicians working in an emergency centre (EC). For doctors working in the African setting, dealing with high patient loads and limited theatre availability, knowledge and proficiency in PSA is a highly valuable and necessary skill. The aim of this study was to audit the practice of PSA in the EC of Steve Biko Academic Hospital.
This was a cross-sectional descriptive audit. Procedures conducted under PSA were identified. An audit of clinical notes and interviews with staff was conducted. Data were analysed using the STAT 12 package. The results were presented as adherence statistics with reference to the PSA guidelines of the Emergency Medicine Society of South Africa (EMSSA).
This audit indicated that documentation of informed consent prior to PSA was poor in this hospital’s EC. No evidence of informed consent was found in any audited cases. Adherence to the other aspects of PSA was also fairly average (below 50% in most). The mean adherence scores for these components were as follows: pre-procedure preparation and equipment check 46.19% (95% CI 36.62–55.76), documented patient pre-evaluation 50.99% (95% CI 46.78–55.18), monitoring during procedure 39.22% (95% CI 34.68–43.75), post procedure monitoring 37.99% (95% CI 32.78–43.20), and overall documentation of procedure 40.69% (95% CI 37.85–43.52). Analysis of adherence to the guidelines between different ranks of doctors demonstrated that the registrars in EM were, in general, more compliant.
This audit identified documentation of informed consent as a major shortcoming in the practice of PSA in this EC. There is also room for improvement in most of the other aspects that were assessed. As part of the clinical audit cycle, the results of this study will be used to initiate changes to increase adherence to the guidelines.
La sédation et l’analgésie d’intervention (SAI) est une compétence vitale chez les médecins travaillant en centre des urgences (CU). Pour les médecins travaillant en Afrique, gérant un grand nombre de patients et une disponibilité limitée des salles d’opération, la connaissance et la familiarisation avec la SAI est une compétence extrêmement précieuse et nécessaire. L’objectif de cette étude était d’auditer la pratique de la SAI au sein du CU de l’hôpital universitaire Steve Biko.
Il s’agissait d’un audit descriptif transversal. Les procédures effectuées dans le cadre de la SAI ont été identifiées. Un audit des notes cliniques et des entretiens avec les membres du personnel ont été réalisés. Les données ont été utilisées en utilisant le logiciel STAT 12. Les résultats ont été présentés sous forme de statistiques de respect, en référence aux directives sur la SAI de la Société sud-africaine de médecine urgentiste (Emergency Medicine Society of South Africa (EMSSA).
Cet audit a indiqué que la documentation du consentement éclairé avant la SAI était de mauvaise qualité dans le CU de cet hôpital. Aucune preuve de consentement éclairé n’a été trouvée dans aucun des cas audités. Le respect des autres aspects de la SAI était également relativement médiocre (inférieure à 50% dans la plupart des cas). Les notes de respect moyennes pour ces composantes étaient telles suit: préparation et vérification du matériel avant la procédure, 46,19% (IC à 95% 36,62–55,76), examen préliminaire documenté du patient, 50,99% (IC à 95% 46,78–55,18), suivi pendant l’intervention, 39,22% (IC à 95% 34,68–43,75), suivi suite à l’intervention, 37,99% (IC à 95% 32,78–43,20), et documentation globale de l’intervention, 40,69% (IC à 95% 37,85–43,52). L’analyse du respect des directives entre différents niveaux de médecins a montré que les registres en MU étaient généralement plus en conformité.
Cet audit a identifié le consentement éclairé comme une lacune majeure de la pratique de la SAI dans ce CU. La plupart des autres aspects évalués peuvent également être améliorés. Dans le cadre de ce cycle d’audits cliniques, les résultats de cet étude seront utilisés afin d’initier des changements visant à augmenter le respect des directives.
Remifentanil vs. propofol controlled infusion for sedation of patients undergoing gastrointestinal endoscopic procedures: A clinical randomized controlled clinical trial
2013, Revista Colombiana de Anestesiologia
La administración de sedación con sistemas de infusión controlada a objetivo (TCI) podría ofrecer una alternativa segura para el manejo del malestar de los pacientes llevados a procedimientos endoscópicos gastrointestinales. Sin embargo, no se conoce qué medicamento de los disponibles para TCI es el más apropiado. El objetivo del estudio fue comparar remifentanilo y propofol en TCI para la sedación de pacientes durante procedimientos endoscópicos gastrointestinales.
Sesenta y nueve pacientes que requerían un procedimiento endoscópico gastrointestinal fueron asignados aleatoriamente a recibir una TCI en sitio efecto (TCIe) de remifentanilo (n = 30) o propofol (n = 39). El desenlace primario fue la satisfacción del paciente. Los desenlaces secundarios incluyeron la satisfacción del gastroenterólogo, se compararon las proporciones de eventos adversos entre los 2 grupos (ocurrencia de arritmias cardiacas, depresión respiratoria leve, depresión respiratoria mayor, bradicardia, hipotensión, dolor, náuseas o vómitos, y ausencia de amnesia) y el nivel de consciencia. Número de registro retrospectivo: NCT01746641.
Las medianas (rango) de satisfacción del paciente entre remifentanilo y propofol fueron 1 (1-2) y 2 (1-4), respectivamente (Chi², p < 0,001). Se encontraron diferencias en la ocurrencia de dolor durante el procedimiento (mediana 2 vs. 1, Chi², p = 0,042), náuseas o vómito (4 vs. 0, Chi², p = 0,01), y ausencia de amnesia (29 vs. 10, Chi², p < 0,001) entre remifentanilo y propofol, respectivamente. Para las otras variables estudiadas no se encontraron diferencias estadísticamente significativas entre los grupos.
El propofol en TCIe parece ser un medicamento adecuado para la sedación de pacientes durante procedimientos endoscópicos gastrointestinales, y presentó menores efectos adversos y mayor satisfacción del paciente. Es probable que con la sinergia de estos 2 medicamentos se pudiera lograr disminuir aún más los efectos adversos.
Target controlled infusion (TCI) for the administration of anesthesia may provide a safe alternative for managing the discomfort of patients undergoing gastrointestinal endoscopic procedures. However, the most appropriate drug available for TCI is yet to be established. The objective of this trial was to compare remifentanil vs. propofol in TCI for sedating patients during GI endoscopy.
Sixty-nine patients requiring GI endoscopies were randomly distributed to receive remifentanil (n = 30) or propofol (n = 39) TCI at the effect site (e). The primary outcome was patient's satisfaction. Secondary outcomes included the gastroenterologist satisfaction, comparison of the percentage of adverse events between the two groups (occurrence of arrhythmias, major respiratory depression, bradycardia, hypotension, pain, nausea or vomiting and absence of amnesia), and the level of awareness. Retrospective registration number is NCT01746641 at Clinicaltrials.gov.
The mean (range) of patient satisfaction with remifentanil vs propofol was 1 (1–2) and 2 (1–4), respectively (χ², p < 0,001). Pain during the procedure was found to differ between remifentanil and propofol (mean 2 vs. 1, χ², p = 0,042), nausea or vomiting (4 vs. 0, χ², p = 0,01), and absence of amnesia (29 vs. 10, χ², p < 0,001), respectively. No statistically significant differences were found between the two groups.
Propofol in TCI seems to be an adequate agent for sedation of patients under- going GI endoscopic procedures, with less adverse effects and higher patient satisfaction. Most likely, the combination of these two drugs may be synergistic and further reduce any adverse effects.
2011 ACCF/AHA/SCAI guideline for percutaneous coronary intervention
2011, Journal of the American College of Cardiology
Citation Excerpt :
The hemodynamic effects have been studied in patients undergoing high-risk PCI (552). Several small studies have addressed the clinical efficacy of the TandemHeart in high-risk patients undergoing PCI (551,553–556). In a single-center report of 68 patients undergoing high-risk PCI using either TandemHeart or Impella Recover 2.5, success rates (>90%) and vascular complications (7%) were similar (553).

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EditorialProcedural sedation terminology: Moving beyond “conscious sedation”*

Abstract

Ann Emerg Med

J Pediatr

Ann Emerg Med

Ann Emerg Med

Practice guidelines for sedation and analgesia by non-anesthesiologists

Anesthesiology

2001 Sedation and Anesthesia Care standards

Consensus conference: anesthesia and sedation in the dental office

JAMA.

Guidelines for the elective use of conscious sedation, deep sedation, and general anesthesia in pediatric patients

Pediatrics

Guidelines for monitoring and management of pediatric patients during and after sedation for diagnostic and therapeutic procedures

Pediatrics

Conscious sedation for pediatric orthopaedic emergencies

Pediatr Emerg Care

Editorial
Procedural sedation terminology: Moving beyond “conscious sedation”*