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  3. Moderate and Deep Sedation in Clinical Practice
  • Cited by 3
Publisher:
Cambridge University Press
Online publication date:
March 2012
Print publication year:
2012
Online ISBN:
9781139084000
DOI:
https://doi.org/10.1017/CBO9781139084000
Subjects:
Anesthesia, Intensive Care, Pain Management, Obstetrics and Gynecology, Reproductive Medicine, Medicine
Information

Book description

Millions of procedures requiring sedation are performed each year; many occur outside of the operating room in both inpatient and outpatient settings. This tremendous growth has resulted in sedation being administered by a wide range of healthcare providers, including non-anesthesiologist physicians, nurses and nurse practitioners. Moderate and Deep Sedation in Clinical Practice is a concise, practical handbook for all medical and surgical professionals who sedate patients. This up-to-date, evidence based, 'how to' manual will: Tell you how to evaluate patients Update you on relevant pharmacologyAdvise you on sedation for specific populations: elderly, pediatric, ICU, emergency room, endoscopy and reproductive technologies Guide you on legal and quality assurance issuesWritten and edited by experts in procedural sedation and sedation education, this book will help users develop safer techniques, policies and procedures. Essential reading for any healthcare provider administering moderate or deep sedation.

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Contents

Page 2 of 2

Contents
  • Chapter 22 - Sedation for assisted reproductive technologies
    pp 281-290
  • View abstract

    Summary

    With the evolution of modern interventional cardiology techniques, the cardiology suite has become a frequent place where the diagnosis and treatment of patients requires the use of procedural sedation. The cardiology suite is designed to meet certain safety parameters. It is typically divided into two main areas, the procedure room and the control room. All patients to be scheduled for an interventional cardiac procedure should undergo a rigorous screening and detailed pre-procedure evaluation for medical risk factors that might predispose the patient to complications during the procedure. This lists the interventional procedures commonly performed in the cardiac catheterization and electrophysiology laboratory, along with their sedation requirements and complications. A unique characteristic of many of the procedures performed in the cardiology suite is that they involve brief periods of intense stimulation followed by long periods of minimal stimulation.
  • Chapter 23 - Sedation for interventional pain management procedures
    pp 291-299
  • View abstract

    Summary

    The demands made on a modern emergency department (ED) are such that having an internal capacity to provide a range of procedural sedation is essential to its functioning. Emergency physicians (EPs) have advanced airway management and resuscitation training to manage complications arising from sedation. A good working relationship between the department of anesthesia and the ED is thus of great importance in creating and maintaining a procedural sedation program. Both moderate and deep sedation have been shown to be safe tools in the hands of EP. Striking a balance between safety and prompt treatment is a prime consideration for the EP. The drug and dose should be primarily chosen as a function of the sedation assessment. For many ED sedations, propofol is chosen for its effects and short duration of action. The chapter also presents a few representative cases describing procedural sedation management of patients in the ED setting.
  • Chapter 24 - Emergency resuscitation algorithms: adults
    pp 300-306
  • View abstract

    Summary

    This chapter emphasizes thorough patient evaluation to identify appropriate intensive care unit (ICU) sedation candidates, and reviews common indications for ICU sedation administration. It examines the risks inherent in under- and oversedation, and reviews the basic pharmacology and administration techniques of commonly utilized ICU sedatives and analgesics. Specific sedatives and analgesics have known pharmacologic effects on contractility, vascular tone, and sympathetic-parasympathetic balance. Certain sedative medications rely upon hepatic inactivation or have active metabolites that require renal elimination. The chapter describes the sedation scales to guide ongoing sedation administration and minimize the chance of under- or oversedation. Cerebral function monitors (CFMs) are primarily utilized in the operating room to monitor anesthesia levels and minimize patient recall of unpleasant intraoperative events. They have yet to be widely accepted for ICU sedation monitoring, and little correlation exists between sedation scale and bispectral index (BIS) readings.
  • Chapter 25 - Emergency resuscitation algorithms: infants and children
    pp 307-313
  • View abstract

    Summary

    This chapter presents a general approach to pediatric sedation, focusing on the unique variables children bring to this clinical setting. It lays emphasis on the specific settings for pediatric sedation and the interplay between setting and sedation plan, clinical preparation, and the potential limitations or complications that must be understood. Knowledge of specific developmental issues (anatomical, physiological, and behavioral) is a prerequisite before provision of sedative drugs. The chapter focuses on the adverse airway events, and presents a brief review of the pediatric airway. The pharmacodynamics and pharmacokinetics of typical sedatives in children has slowly emerged for many agents over the years. While propofol remains an excellent sedative drug for the pediatric intensive care unit (ICU), its use now requires careful clinical monitoring and caution. Finally, the chapter presents the general comments regarding the most frequently used sedatives, with particular emphasis on the unique characteristics of each.

Page 2 of 2

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