Downloaded 108 times
Uploaded bytaem
Sedation monitoring and post sedation recovery and discharge
This document outlines guidelines for procedural sedation and analgesia. It recommends having appropriate monitoring equipment and administering analgesics before sedatives. Patients should be monitored until recovery to their baseline mental status. At minimum, procedural sedation requires one clinician to perform the procedure while another continuously monitors the patient. Regular monitoring of vital signs, oxygen saturation, and ventilation is important. The use of capnography may help detect respiratory complications earlier than pulse oximetry alone. Patients must meet discharge criteria related to symptoms, vital signs, and orientation before being discharged.
More Related Content
![The basics of peds anesthesia [autosaved]](https://cdn.slidesharecdn.com/ss_thumbnails/thebasicsofpedsanesthesiaautosaved-111017032903-phpapp01-thumbnail.jpg?width=640&height=640&fit=bounds)
Similar to Sedation monitoring and post sedation recovery and discharge
![Apporach to lung biopsy [Auto-saved].pptx latest](https://cdn.slidesharecdn.com/ss_thumbnails/apporachtolungbiopsyauto-saved-251211225655-93258539-thumbnail.jpg?width=640&height=640&fit=bounds)
Sedation monitoring and post sedation recovery and discharge
- 1. Sedation Monitoring andPost-sedation Recovery and Discharge
- 2. Key Principles ofProcedural Sedation and Analgesia • Determine appropriate level of sedation desired • Have appropriate monitoring and rescue equipment • Administer analgesic before sedative • Titrate agents to desired level of sedation • Observe and monitor until recovery to baseline mental status
- 3. Equipment and Supplies Recommendations • Intravenous equipment • Basic & advance airway management equipment • Pharmacologic antagonist • Emergency medication
- 4. Procedural Sedation Monitoring • Interactive monitoring • Mechanical monitoring
- 5. Procedural Sedation Monitoring • Interactive monitoring: Direct observation of patient to access - Depth of sedation - Respiratory function & Hemodynamics Unobstructed view of the patient’s face, mouth, chest wall
- 6. In patients undergoingprocedural sedation and analgesia in the emergency department, what is the minimum number of personnel necessary to manage complications?
- 7. • Mostly, oneclinician performs the procedure while another (usually a nurse) observe and continuously monitor the patient Level C recommendations Clinical Policy: Procedural Sedation and Analgesia in the Emergency Department Ann Emerg Med. 2014;63:247-258.
- 8. Monitoring Depth ofsedation • Check response to verbal commands • If verbal response is not possible, “thumbs up” • Deep sedation: response to a more profound stimulus • Response limited to reflex withdrawal from a painful stimulus is not considered a purposeful response
- 9. Scale monitoring depthof sedation Moderate sedation: Do not exceed level 4 Deep sedation score: Level 5
- 10. Regular patient monitoringis more important than the application of scales
- 11. Bispectral Index monitoring • uses processed electroencephalogram signals to measure the depth of sedation • 100 = complete alertness, • 0 = no cortical activity at all • 40 - 60 is believed to be consistent with GA
- 12. Monitoring • Interactivemonitoring • Mechanical monitoring
- 13. Mechanical Monitoring •Arterial oxygenation • Ventilation • Vital sign • ECG monitoring
- 14. Arterial oxygenation •Pulse oxymetry is not a substitute for monitoring ventilation • Hypoventilation or apnea develop before oxygen saturation decreases especially “Patient who receive supplemental oxygen”
- 15. Ventilation • Capnography • ETco2 correlates with arterial Pco2 • ETco2 > 50 mmHg or ↑>10 mmHg indicates hypoventilation
- 17. In patients undergoingprocedural sedation and analgesia in the emergency department, Does the routine use of capnography reduce the incidence of adverse respiratory events?
- 18. Level B recommendation • Capnography* may be used as an adjunct to pulse oximetry and clinical assessment to detect hypoventilation and apnea earlier than pulse oximetry and/or clinical assessment alone in patients undergoing procedural sedation and analgesia in the ED. • Capnography includes all forms of quantitative exhaled carbon dioxide analysis.
- 19. Vital Signs •Before the procedure • After each dose of sedative • Regular intervals during the procedure • During initial of recovery period • Before discharge
- 20. Recommendations Level of Sedation LOC Heart Rate Respiratory Rate BP O2 Saturation Capno graphy Minimal Observe frequently q 15 min q 15 min q 15 min and after sedative boluses Continuously - Moderate or Dissociative Observe constantly Continuously Continuous direct observation q 5 min & after sedative boluses Continuously Consider continuously Deep Observe constantly Continuously Continuous direct observation q 5 min & after sedative boluses Continuously Recommend continuously If recording is performed automatically, Device alarms should be set to alert
- 21. Cardiac monitoring Recommendedfor: • Preexisting cardiac disease • Dysrhythmias • During procedures in which the cardiac rhythm is of interest
- 22. Post-Sedation Recovery •Recovery and discharge under supervision of operating practitioner or a licensed physician. • A nurse or other individual should monitor until appropriate discharge criteria are satisfied • Preparation for management of complications.
- 23. Observation Duration •In most cases, prolong observation beyond 30 min is unlikely to be necessary • Longer duration in patients who receive reversal agents
- 24. Discharge Criteria •Low risk procedure that additional monitoring is un necessary. • Symptoms should be well-controlled. • Stable V/S and respiratory and cardiac function • Alert and oriented or returned to baseline • A reliable person who can provide support and supervision at least a few hours. • Scoring systems may assist in documentation. • Patient instruction
- 26. 10/12 points required before discharge
- 28. Pediatric Discharge Criteria • Young infants or children who are handicapped should return to the level of responsiveness observed before sedation • Because of the significant risk of apnea after sedation, term infants with postconceptual ages (PCA) ≤45 weeks and former premature infants with PCA <60 weeks should undergo prolonged observation of respiratory status prior to discharge
- 29. Minimum Duration ofObservation for Infants • All infants with PCA ≤45 weeks – 12 hours • Pre-term infants with PCA 46 to 60 weeks and significant comorbidities – 12 hours • Healthy pre-term infants with PCA 46 to 60 weeks – 6 hours (12 hours if given opioids or other medications with significant respiratory depressant effects)
- 30. • Patients, whodevelop apnea during observation, warrant prolonged observation until they are free of apnea for at least 12 hours. • In some patients with frequent apneic episodes, caffeine administration may be appropriate.
- 32.
- 33.
Editor's Notes
- #5 Level C recommendation Clinical Policy: Procedural Sedation and Analgesia in the Emergency Department Ann Emerg Med. 2005;45:177-196
- #18 Phase I: At the start of exhalation, CO2 concentration in the exhaled gas is essentially zero, representing gas from the anatomic dead space that does not participate in gas exchange. Phase II: As the anatomic dead space is exhaled, CO2 concentration rises as alveolar gas exits the airway. Phase III: For most of exhalation, CO2 concentration is constant and reflects the concentration of CO2 in alveolar gas. Phase IV: During inhalation, CO2 concentration decreases to zero as atmospheric air enters the airway. [Reproduced with permission from Brauss B, Hess DR: Capnography for procedural sedation and analgesia in the emergency department. Ann
- #20 Capnography allows continuous measurement of exhaled carbon dioxide and displays the resulting waveform graphically. It provides an advantage over pulse oximetry alone by identifying respiratory depression more consistently. Capnometry is the numeric display of exhaled carbon dioxide concentrations. ETCO2 is the highest value of carbon dioxide measured during the end of expiration of each breath