| Procedural sedation and analgesia | |
|---|---|
| Intervention | |
| 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] It was previously referred to as conscious sedation.
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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 |
This technique is often used in the emergency department for the performance of painful or uncomfortable procedures. It has been used for setting fractures, draining abscesses, reducing dislocations, performing endoscopy, imaging procedures in patients unable to hold still, cardioversion[3] and during dental procedures.
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 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.
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.
Many institutions have protocols that are used during procedural sedation.
Some resistance to sedation techniques used outside the operating room by non-anesthetists has been voiced.[8]
Procedural sedation used to be referred to as conscious sedation.
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