MeSH D016292 | MedlinePlus 007409 | |
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."
Contents
Definitions
The American Society of Anesthesiologists defines the continuum of sedation as follows:
Medical uses
This technique is often used in the emergency department for the performance of painful or uncomfortable procedures. Common purposes include:
Sedatives/dissociative agents
Analgesics
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. However, in the emergency room setting, conscious sedation is usually administered without waiting the full 6 hours unless there is clear evidence that the patient may not be able to maintain his/her airway on their own. The most common drug combination used is Versed (midazolam) for sedation (due to its potency and its ability to induce temporary amnesia, which can be beneficial because the unpleasantness of the procedure and any related sights, sounds, or smells) and Fentanyl for analgesia. Despite this being the most frequently used drug combination, variations are not uncommon due to factors such as patient allergies or clinician preference.
Complications
Complications do not depend on the sedative agent used. Some agents are more likely to cause complications than others, but all sedative agents can cause complications if not used properly. Titration is a common technique used to reduce 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.
Electrocardiography, pulse oximetry, capnography and blood pressure monitoring are essential, as is the use of supplementary oxygen.
Controversies
Some resistance to sedation techniques used outside the operating room by non-anesthetists has been voiced.
History
Procedural sedation used to be referred to as conscious sedation. When the patient is adequately sedated this is known as a (+)Ruiz sign.