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How To Do Procedural Sedation and Analgesia
Additional Considerations
Degrees of sedative-hypnotic sedation are defined as: Anxiolysis (minimal sedation): Consciousness and interactivity are retained; coordination and cognition may be impaired. Moderate sedation: Consciousness is depressed; response to verbal requests or touch is retained. Deep sedation: Consciousness is depressed; arousal is difficult and may require repeated verbal or painful stimuli; airway patency may decrease; spontaneous breathing may slow. General anesthesia: Patient is unconscious and unresponsive to stimuli; respiratory depression or airway compromise is frequent; cardiovascular compromise may occur. General anesthesia is not expected with PSA; however, PSA providers must be able to reverse general anesthesia and provide cardiopulmonary support as needed. Dissociative sedation (unique toketamine; distinct from sedative-hypnotic sedation): analgesia and amnesia, preservation of spontaneous breathing, airway reflexes, and cardiopulmonary function Capnography is a more sensitive indicator of respiratory depression than oximetry, and, unlike oximetry, remains a reliable indicator when supplemental oxygen is being given. Respiratory depression occurs most commonly at the beginning of sedation and during the recovery period after the sedation. How To Do Bag-Valve-Mask (BVM) Ventilation usually suffices for temporary ventilatory support. Hypotension should be anticipated during PSA. IV fluids (eg, 0.9% saline) usually can correct procedural hypotension. In patients with low blood pressure prior to PSA, consider a hemodynamically neutral or supportive alternative (ie,etomidateorketamine). Pregnant or possibly pregnant staff members should be excluded from environments in which nitrous oxide is used because nitrous oxide is a teratogen. 