Ensuring safe moderate sedation practice

Ensuring safe moderate sedation practice

Sedation involves the pharmacologically induced reductions in consciousness across various states, each characterised by differing levels of consciousness, ranging from minimal to complete unconsciousness. These states include minimal sedation/ anxiolysis, moderate sedation and analgesia (also known as conscious sedation), dissociative sedation, deep sedation, and general anaesthesia.

Moderate sedation/analgesia involves inducing a state of reduced consciousness where patients maintain the ability to respond purposefully to verbal commands and light tactile stimulation.

This practice is widespread in healthcare settings, including minor procedures in various locations such as cardiac catheterisation laboratories, endoscopy suites, emergency rooms, and dentist offices, and can be administered by different healthcare providers, including physicians and dentists.

Indications for moderate sedation/analgesia include procedures causing significant discomfort, with the sedation level tailored to the anticipated pain and the necessity for patient immobility. Patient stability during the procedure is also a crucial factor in decision-making, with attention given to vital sign stability.

Preparation for conscious sedation/analgesia is vital and should ideally occur in a simulated environment before the procedure. Selection of agents and techniques relies on factors such as practitioner expertise, patient-related medical conditions, and procedural nature, with considerations given to the risk of inadvertently inducing deeper sedation than intended.

Practitioners must be prepared to manage unexpected changes in sedation levels, particularly for moderate sedation, which may involve addressing compromised airway or hypoventilation and supporting cardiovascular function in patients experiencing fluctuations in blood pressure or heart rate.

Pre-procedure patient preparation, according to the American Society of Anesthesiologists (ASA) guidelines, involves consultation with medical specialists when needed, informing patients about the benefits and risks of sedatives/analgesics, providing pre-procedure instructions and counselling, and ensuring appropriate fasting.

During the procedure, assessing the time and nature of the last oral intake and evaluating the risk of pulmonary aspiration of gastric contents are recommended before determining the target level of sedation and deciding whether the procedure should proceed.

Following standardised operative checklist procedures, such as the World Health Organization template, is recommended, including verifying identity, procedure, and consent, marking the site/side; checking for needed medications and monitoring devices, assessing for airway difficulties/anomalies; confirming team members’ roles and preparation, and displaying necessary images.

At the end of the procedure, ensuring each team member confirms stability in their role before leaving the procedure room is essential for patient safety and continuity of care.

References are available on request. SF