Procedural sedation
Encyclopedia
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." It was previously referred to as conscious sedation.
, imaging procedures in patients unable to hold still, cardioversion
and during dental procedures.
Electrocardiography, pulse oximetry, capnography and blood pressure monitoring are essential, as is the use of supplementary oxygen.
Definitions
The American Society of Anesthesiologists defines the continuum of sedation as follows:| 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 |
Medical uses
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 endoscopyEndoscopy
Endoscopy means looking inside and typically refers to looking inside the body for medical reasons using an endoscope , an instrument used to examine the interior of a hollow organ or cavity of the body. Unlike most other medical imaging devices, endoscopes are inserted directly into the organ...
, imaging procedures in patients unable to hold still, cardioversion
Cardioversion
Cardioversion is a medical procedure by which an abnormally fast heart rate or cardiac arrhythmia is converted to a normal rhythm, using electricity or drugs. Synchronized electrical cardioversion uses a therapeutic dose of electric current to the heart, at a specific moment in the cardiac cycle...
and during dental procedures.
Analgesics
- Fentanyl
- MorphineMorphineMorphine is a potent opiate analgesic medication and is considered to be the prototypical opioid. It was first isolated in 1804 by Friedrich Sertürner, first distributed by same in 1817, and first commercially sold by Merck in 1827, which at the time was a single small chemists' shop. It was more...
- KetamineKetamineKetamine is a drug used in human and veterinary medicine. Its hydrochloride salt is sold as Ketanest, Ketaset, and Ketalar. Pharmacologically, ketamine is classified as an NMDA receptor antagonist...
: Small doses of ketamine have been found to be safer than fentanyl when used in combination with propofol.
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.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.