J Korean Med Assoc.  2013 Apr;56(4):264-270. 10.5124/jkma.2013.56.4.264.

The current state of sedation outside the operating room

Affiliations
  • 1Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, College of Medicine, Seoul, Korea. p6c8s17@catholic.ac.kr

Abstract

The demand for sedation outside of the operating room for diagnostic or therapeutic procedures has recently been dramatically increasing. The Joint Commission International (JCI) is pressing domestic hospitals trying to obtain JCI certification to accept its sedation policies. This article aimed to investigate recent trends in sedation and suggest desirable directions for safe and high-quality sedation. The most active areas in research are procedural sedation, sedation in the intensive care unit (ICU), and pediatric sedation. Patient safety and performance of procedures without complications are the most important goals during sedation. According to the JCI regulation, noninvasive blood pressure, electrocardiography, pulse oximetry and capnography are the basic requirements, and sedation personnel should be separate from those who perform the procedure. Careful preprocedural assessment and tight intra-procedural monitoring for airway obstruction are critical in procedural sedation. Many merits of dexmedetomidine in procedural sedation have been reported despite its hemodynamic risks. Daily intermittent interruption is the main trend in ICU sedation providing better outcomes for mechanically ventilated patients. Analgosedation in the ICU is initial analgesia starting with remifentanil and later adding sedatives if required. Individual readjustment of the dosage using a sedation scoring system is a key requirement for successful results in ICU sedation. Ketofol, mixture of ketamine and propofol, has recently become popular for painful pediatric procedures. Pediatric sedation (especially for those < or = 3 years) with computed tomography or magnetic resonance imaging examination has a greater risk of hypoxia, but pediatric sedation experts are lacking. In conclusion, there is an urgent need for the nationwide establishment of standard sedation regulation, and securing or training sedation specialists.

Keyword

Sedation; Ambulatory surgery; Joint Commission on Accreditation

MeSH Terms

Airway Obstruction
Ambulatory Surgical Procedures
Analgesia
Anoxia
Blood Pressure
Capnography
Certification
Dexmedetomidine
Electrocardiography
Hemodynamics
Humans
Hypnotics and Sedatives
Intensive Care Units
Joints
Ketamine
Magnetic Resonance Imaging
Operating Rooms
Oximetry
Patient Safety
Piperidines
Propofol
Specialization
Dexmedetomidine
Hypnotics and Sedatives
Ketamine
Piperidines
Propofol

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Reference

1. Ramsay MA, Savege TM, Simpson BR, Goodwin R. Controlled sedation with alphaxalone-alphadolone. Br Med J. 1974. 2:656–659.
Article
2. Pino RM. The nature of anesthesia and procedural sedation outside of the operating room. Curr Opin Anaesthesiol. 2007. 20:347–351.
Article
3. Eichhorn V, Henzler D, Murphy MF. Standardizing care and monitoring for anesthesia or procedural sedation delivered outside the operating room. Curr Opin Anaesthesiol. 2010. 23:494–499.
Article
4. American Society of Anesthesiologists. Standards for basic anesthetic monitoring [Internet]. 2011. American Society of Anes-thesiologists;Available from: http://www.asahq.org/For-Members/~/media/For%20Members/documents/Standards%20Guidelines%20Stmts/Basic%20Anesthetic%20Monitoring%202011.ashx.
5. Metzner J, Posner KL, Domino KB. The risk and safety of anesthesia at remote locations: the US closed claims analysis. Curr Opin Anaesthesiol. 2009. 22:502–508.
Article
6. Vargo JJ, Cohen LB, Rex DK, Kwo PY. Position statement: nonanesthesiologist administration of propofol for GI endoscopy. Gastrointest Endosc. 2009. 70:1053–1059.
Article
7. Taghinia AH, Shapiro FE, Slavin SA. Dexmedetomidine in aesthetic facial surgery: improving anesthetic safety and efficacy. Plast Reconstr Surg. 2008. 121:269–276.
Article
8. Moerman AT, Herregods LL, De Vos MM, Mortier EP, Struys MM. Manual versus target-controlled infusion remifentanil administration in spontaneously breathing patients. Anesth Analg. 2009. 108:828–834.
Article
9. Hval K, Thagaard KS, Schlichting E, Raeder J. The prolonged postoperative analgesic effect when dexamethasone is added to a nonsteroidal anti-inflammatory drug (rofecoxib) before breast surgery. Anesth Analg. 2007. 105:481–486.
Article
10. Awad IT, Chung F. Factors affecting recovery and discharge following ambulatory surgery. Can J Anaesth. 2006. 53:858–872.
Article
11. Salgado DR, Favory R, Goulart M, Brimioulle S, Vincent JL. Toward less sedation in the intensive care unit: a prospective observational study. J Crit Care. 2011. 26:113–121.
Article
12. Rhoney DH, Murry KR. National survey of the use of sedating drugs, neuromuscular blocking agents, and reversal agents in the intensive care unit. J Intensive Care Med. 2003. 18:139–145.
Article
13. Bauer TM, Ritz R, Haberthur C, Ha HR, Hunkeler W, Sleight AJ, Scollo-Lavizzari G, Haefeli WE. Prolonged sedation due to accumulation of conjugated metabolites of midazolam. Lancet. 1995. 346:145–147.
Article
14. Nelsen JL, Haas CE, Habtemariam B, Kaufman DC, Partridge A, Welle S, Forrest A. A prospective evaluation of propylene glycol clearance and accumulation during continuous-infusion lorazepam in critically ill patients. J Intensive Care Med. 2008. 23:184–194.
Article
15. Kress JP, Pohlman AS, O'Connor MF, Hall JB. Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation. N Engl J Med. 2000. 342:1471–1477.
Article
16. Pandharipande P, Cotton BA, Shintani A, Thompson J, Pun BT, Morris JA Jr, Dittus R, Ely EW. Prevalence and risk factors for development of delirium in surgical and trauma intensive care unit patients. J Trauma. 2008. 65:34–41.
Article
17. Pandharipande PP, Pun BT, Herr DL, Maze M, Girard TD, Miller RR, Shintani AK, Thompson JL, Jackson JC, Deppen SA, Stiles RA, Dittus RS, Bernard GR, Ely EW. Effect of sedation with dexmedetomidine vs lorazepam on acute brain dysfunction in mechanically ventilated patients: the MENDS randomized controlled trial. JAMA. 2007. 298:2644–2653.
Article
18. Riker RR, Picard JT, Fraser GL. Prospective evaluation of the Sedation-Agitation Scale for adult critically ill patients. Crit Care Med. 1999. 27:1325–1329.
Article
19. Ely EW, Truman B, Shintani A, Thomason JW, Wheeler AP, Gordon S, Francis J, Speroff T, Gautam S, Margolin R, Sessler CN, Dittus RS, Bernard GR. Monitoring sedation status over time in ICU patients: reliability and validity of the Richmond Agitation-Sedation Scale (RASS). JAMA. 2003. 289:2983–2991.
Article
20. LeBlanc JM, Dasta JF, Kane-Gill SL. Role of the bispectral index in sedation monitoring in the ICU. Ann Pharmacother. 2006. 40:490–500.
Article
21. Corbett SM, Montoya ID, Moore FA. Propofol-related infusion syndrome in intensive care patients. Pharmacotherapy. 2008. 28:250–258.
Article
22. Riker RR, Shehabi Y, Bokesch PM, Ceraso D, Wisemandle W, Koura F, Whitten P, Margolis BD, Byrne DW, Ely EW, Rocha MG. SEDCOM (Safety and Efficacy of Dexmedetomidine Compared With Midazolam) Study Group. Dexmedetomidine vs midazolam for sedation of critically ill patients: a randomized trial. JAMA. 2009. 301:489–499.
Article
23. Jakob SM, Ruokonen E, Grounds RM, Sarapohja T, Garratt C, Pocock SJ, Bratty JR, Takala J. Dexmedetomidine for Long-Term Sedation Investigators. Dexmedetomidine vs midazolam or propofol for sedation during prolonged mechanical ventilation: two randomized controlled trials. JAMA. 2012. 307:1151–1160.
Article
24. Babl FE, Belousoff J, Deasy C, Hopper S, Theophilos T. Paediatric procedural sedation based on nitrous oxide and ketamine: sedation registry data from Australia. Emerg Med J. 2010. 27:607–612.
Article
25. Shavit I, Leder M, Cohen DM. Sedation provider practice vari-ation: a survey analysis of pediatric emergency subspecialists and fellows. Pediatr Emerg Care. 2010. 26:742–747.
26. Andolfatto G, Willman E. A prospective case series of pediatric procedural sedation and analgesia in the emergency department using single-syringe ketamine-propofol combination (ketofol). Acad Emerg Med. 2010. 17:194–201.
Article
27. Kannikeswaran N, Mahajan PV, Sethuraman U, Groebe A, Chen X. Sedation medication received and adverse events related to sedation for brain MRI in children with and without developmental disabilities. Paediatr Anaesth. 2009. 19:250–256.
Article
28. Cravero JP, Blike GT, Beach M, Gallagher SM, Hertzog JH, Havidich JE, Gelman B. Pediatric Sedation Research Consortium. Incidence and nature of adverse events during pediatric sedation/anesthesia for procedures outside the operating room: report from the Pediatric Sedation Research Consortium. Pediatrics. 2006. 118:1087–1096.
Article
29. Kweon TD. Sedation under JCI standard. Korean J Anesthesiol. 2011. 61:190–194.
Article
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