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35 results in Moderate and Deep Sedation in Clinical Practice

Page 1 of 2

  • Chapter 9 - Physician assistants and nurse practitioners

  • Edited by Richard D. Urman, Alan D. Kaye
  • Book:
    Moderate and Deep Sedation in Clinical Practice
    Published online:
    05 March 2012
    Print publication:
    09 February 2012, pp 115-119

  • Summary

    This chapter deals with important considerations with regard to pre-procedure, peri-procedure, and post-procedure patient assessment and pain management strategies. Practitioner training and experience in administering sedation is an important consideration. For most patients, pain assessments and establishment of pain treatment goals can be performed by a non-anesthesiologist. Appropriate assessment of pain increases caregiver awareness of pain status, allows for the delivery of appropriate interventions, provides for feedback, decreases both patient and caregiver frustration, and improves patient satisfaction. The chapter outlines the most common pain assessment tools in current use in general and special populations. In the general population, which includes mature children, adults, and the cognitively intact elderly, the use of self-report scales has been validated as the most reliable indicator of pain. With appropriate vigilance, planning, and continuous communication between team members, many of the barriers involved in planning and executing an effective pain management strategy can be overcome.

  • Chapter19 - Pediatric sedation

  • Edited by Richard D. Urman, Alan D. Kaye
  • Book:
    Moderate and Deep Sedation in Clinical Practice
    Published online:
    05 March 2012
    Print publication:
    09 February 2012, pp 230-244

  • Summary

    Simulators are very effective in healthcare education, and they can be used for teaching the safe administration of sedation and/or analgesia. There are several classifications of simulators. One of them is based on the media used in simulation. This classification divides all simulators into two major categories: computer screen-based simulators and mannequin-based simulators. The following are the main high-fidelity mannequin-based computer-driven simulators utilized for teaching procedural sedation and analgesia: Laerdal SimMan simulators; Medical Education Technologies (METI) simulators; and Gaumard simulators. METI simulators have the most elaborate design, with built-in physiologic and pharmacologic systems that can be used for modeling different clinical conditions, and they have a sophisticated scenario editor/player. Laerdal SimMan simulators have advanced programming features that allow them to run preprogrammed scenarios as well as to be used on the fly. Any simulator is capable of delivering an exciting and valuable educational experience to both the trainees and instructors.

  • Chapter 11 - Management of complications of moderate and deep sedation

  • Edited by Richard D. Urman, Alan D. Kaye
  • Book:
    Moderate and Deep Sedation in Clinical Practice
    Published online:
    05 March 2012
    Print publication:
    09 February 2012, pp 135-149

  • Summary

    Adequate patient monitoring is essential for successful and safe practice of sedation. Monitoring must be performed by a designated healthcare provider and should be performed during all phases of the procedure. Healthcare providers should be familiar with monitoring equipment and be able to interpret the data obtained from it. Monitoring for sedation procedures primarily involves the observation of blood pressure, oxygenation, respiratory function, electrocardiography (ECG) and capnography tracings. Although patients undergoing sedation are not exposed to potent inhalation agents used for general anesthesia, the importance of temperature monitoring should not be underestimated. Patients undergoing minor surgical procedures are generally exposed to the ambient environment. The maximum concentration of carbon dioxide is reached at the end of exhalation, and then identified as end-tidal CO2 (ETCO2). During sedation, the use of crystalloid solutions is generally recommended for the intravenous replacement of fluids.

  • Chapter 2 - Pharmacology principles

  • Edited by Richard D. Urman, Alan D. Kaye
  • Book:
    Moderate and Deep Sedation in Clinical Practice
    Published online:
    05 March 2012
    Print publication:
    09 February 2012, pp 8-32

  • Summary

    This chapter focuses on the pharmacology of the drugs commonly used to provide moderate and deep sedation and their available reversal agents. Intravenous sedative and analgesic drugs should be given in small, incremental doses titrated to desired end points of sedation and analgesia, with adequate time allowed between doses to achieve those effects. Preemptive analgesia is a treatment that is initiated before surgical procedure to reduce sensitization of pain pathways. Potential drug interactions require the clinician providing sedation to be cognizant of potential drug-drug effects, which can lead to morbidity and mortality. Opioids in combination with benzodiazepines provide adequate moderate and/or deep sedation and analgesia for many potentially painful procedures. Other drugs used for deep sedation include propofol, ketamine, dexmedetomidine, and etomidate. Local anesthetics (LA) have the potential to produce deleterious side effects. The choice of a local anesthetic and care in its use are the primary determinants of toxicity.

  • Chapter 8 - Nursing considerations for sedation

  • Edited by Richard D. Urman, Alan D. Kaye
  • Book:
    Moderate and Deep Sedation in Clinical Practice
    Published online:
    05 March 2012
    Print publication:
    09 February 2012, pp 102-114

  • Summary

    This chapter focuses on the pharmacology of the drugs commonly used to provide moderate and deep sedation and their available reversal agents. Intravenous sedative and analgesic drugs should be given in small, incremental doses titrated to desired end points of sedation and analgesia, with adequate time allowed between doses to achieve those effects. Preemptive analgesia is a treatment that is initiated before surgical procedure to reduce sensitization of pain pathways. Potential drug interactions require the clinician providing sedation to be cognizant of potential drug-drug effects, which can lead to morbidity and mortality. Opioids in combination with benzodiazepines provide adequate moderate and/or deep sedation and analgesia for many potentially painful procedures. Other drugs used for deep sedation include propofol, ketamine, dexmedetomidine, and etomidate. Local anesthetics (LA) have the potential to produce deleterious side effects. The choice of a local anesthetic and care in its use are the primary determinants of toxicity.

  • Chapter 25 - Emergency resuscitation algorithms: infants and children

  • Edited by Richard D. Urman, Alan D. Kaye
  • Book:
    Moderate and Deep Sedation in Clinical Practice
    Published online:
    05 March 2012
    Print publication:
    09 February 2012, pp 307-313

  • 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.

  • Chapter 20 - Sedation in the office/outpatient setting

  • Edited by Richard D. Urman, Alan D. Kaye
  • Book:
    Moderate and Deep Sedation in Clinical Practice
    Published online:
    05 March 2012
    Print publication:
    09 February 2012, pp 245-253

  • Summary

    The number of minimally invasive procedures and diagnostic imaging examinations requiring moderate sedation has increased greatly in the radiology department. Many procedures in radiology are performed with the use of iodinated contrast media, and safe use of contrast media is important to everyday radiology practice. Providing moderate sedation in the magnetic resonance imaging (MRI) suite presents both patient and environmental challenges. The most common need for moderate sedation in MRI arises from severe anxiety from claustrophobia while in the scanner. It is important to limit patient movement to acquire clear diagnostic images, and in some instances patients require deep sedation or general anesthesia administered by an anesthesiologist. The American College of Radiology and the Joint Commission have published safety guidelines and alerts, and all personnel working in the MRI environment must review these guidelines and receive facility-specific safety training and screening prior to caring for patients in the environment.

  • Chapter 5 - Patient monitoring, equipment, and intravenous fluids

  • Edited by Richard D. Urman, Alan D. Kaye
  • Book:
    Moderate and Deep Sedation in Clinical Practice
    Published online:
    05 March 2012
    Print publication:
    09 February 2012, pp 57-76

  • Summary

    Adequate patient monitoring is essential for successful and safe practice of sedation. Monitoring must be performed by a designated healthcare provider and should be performed during all phases of the procedure. Healthcare providers should be familiar with monitoring equipment and be able to interpret the data obtained from it. Monitoring for sedation procedures primarily involves the observation of blood pressure, oxygenation, respiratory function, electrocardiography (ECG) and capnography tracings. Although patients undergoing sedation are not exposed to potent inhalation agents used for general anesthesia, the importance of temperature monitoring should not be underestimated. Patients undergoing minor surgical procedures are generally exposed to the ambient environment. The maximum concentration of carbon dioxide is reached at the end of exhalation, and then identified as end-tidal CO2 (ETCO2). During sedation, the use of crystalloid solutions is generally recommended for the intravenous replacement of fluids.

  • Chapter 10 - High-risk patients: sedation considerations in coexisting disease

  • Edited by Richard D. Urman, Alan D. Kaye
  • Book:
    Moderate and Deep Sedation in Clinical Practice
    Published online:
    05 March 2012
    Print publication:
    09 February 2012, pp 120-134

  • Summary

    This chapter covers pre-screening, history and physical for evaluation of patients who are potential candidates for procedures under sedation, as well as instructions for patients. Patients for elective procedures may be referred by their primary care physician or may be self-referred. Screening, evaluation, and instruction of patients requires clinical experience, and clerical staff members should not be performing any more than simple initial screening or instructing patients as to time, location, and routine standard instructions. The scope of practice of the surgeon/practitioner/physician(s) involved and the individual facility determine the range of procedures possible. The setting may be quite flexible and general (an operating room) or very specifically designed and equipped. Procedures should be scheduled in locations equipped both for the procedure and for sedation and any contingencies that can be routinely expected as a result of either the procedure or the patient.

  • Chapter 15 - Sedation in the endoscopy suite

  • Edited by Richard D. Urman, Alan D. Kaye
  • Book:
    Moderate and Deep Sedation in Clinical Practice
    Published online:
    05 March 2012
    Print publication:
    09 February 2012, pp 181-196

  • Summary

    Nurse practitioners (NPs) and physician assistants (PAs) are healthcare professionals committed to delivering high-quality health care, and they strive to meet the needs of their patients in an effective, caring, and efficient manner. There are several entities that govern how NPs and PAs can practice. These include but are not limited to the Centers for Medicare Systems (CMS), Medicare Conditions of Participation (CoP), the Joint Commission (TJC), state law, private payer policies, established institutional polices and medical staff bylaws and the defined scopes of practice of the NP or PA. This chapter provides clarification on each of the entities' policies regarding NPs and PAs providing moderate sedation and highlights the nuances of such language. All practitioners should have the ability to manage complications during moderate sedation and have the ability to activate the appropriate emergency response team for that practice area.

  • Chapter 16 - Sedation in the interventional cardiology suite

  • Edited by Richard D. Urman, Alan D. Kaye
  • Book:
    Moderate and Deep Sedation in Clinical Practice
    Published online:
    05 March 2012
    Print publication:
    09 February 2012, pp 197-208

  • Summary

    Certain patient populations provide challenging clinical situations for the sedation provider. Patients with cardiovascular disease, chronic obstructive pulmonary disease (COPD), chronic renal failure, obesity, or advanced age are considered high risk and possess a higher rate of procedural complications. This chapter discusses important features of these higher-risk patients and practice management when sedation is required. COPD is frequently found in patients with chronic bronchitis or emphysema. Common procedural complications in this patient population include hypoventilation (hypoxemia and hypercapnia) and bronchospasm. Bronchospasm manifests as wheezing, and it is commonly caused by an exacerbation of the patient's COPD, but an anaphylactoid reaction to a sedation medication should be ruled out. Patients with known coronary artery disease (CAD) who become oversedated experience cardiac complications related to hypotension and/or hypoxemia. Medication used for sedation should be titrated in slowly, carefully watching hemodynamic response to the medication.

  • Chapter 7 - Quality, legal, and risk management considerations: ensuring program excellence

  • Edited by Richard D. Urman, Alan D. Kaye
  • Book:
    Moderate and Deep Sedation in Clinical Practice
    Published online:
    05 March 2012
    Print publication:
    09 February 2012, pp 85-101

  • Summary

    The modern practice of sedation is the end result of a process of evolution in alteration of consciousness, likely starting with the discovery of the analgesic properties of ether. Recent technological advances have drastically changed the practice of sedation. One of the most significant was certainly the development of pulse oximetry during World War II by Glen Millikan. In 2002, the American Society of Anesthesiologists (ASA) appointed a task force to update practice guidelines for non-anesthesiologists administering sedation and analgesia. The Association of periOperative Registered Nurses (AORN) has produced guidelines for what every registered nurse should know about "conscious sedation". According to the AORN, moderate sedation/analgesia is produced by the administration of amnesic, analgesic, and sedative pharmacologic agents. With continued attention to a high standard of safety, many different professionals are able to provide sedation services to those patients who need them.

  • Chapter 14 - Sedation in the radiology suite

  • Edited by Richard D. Urman, Alan D. Kaye
  • Book:
    Moderate and Deep Sedation in Clinical Practice
    Published online:
    05 March 2012
    Print publication:
    09 February 2012, pp 168-180

  • Summary

    The nurse plays a very important role in administering procedural sedation and monitoring the patient receiving it. Receiving specialized training and adhering to strict institutional standards helps to keep patients safe. The nurse's primary responsibility during procedural sedation is exclusively to that patient. The American Association of Nurse Anesthetists (AANA) suggests that the registered nurse managing and monitoring the patient receiving sedation and analgesia should have no other responsibilities during the procedure. One of the most important things the nurse can do to prevent complications is to avoid overmedication. Intravenous sedative and analgesic drugs should be given in small, incremental doses that are titrated to the desired end point of sedation and analgesia. The American Society of Anesthesiologists (ASA) agrees that continued observation, monitoring, and predetermined discharge criteria decrease the likelihood of adverse outcomes for both moderate and deep sedation.

  • Chapter 23 - Sedation for interventional pain management procedures

  • Edited by Richard D. Urman, Alan D. Kaye
  • Book:
    Moderate and Deep Sedation in Clinical Practice
    Published online:
    05 March 2012
    Print publication:
    09 February 2012, pp 291-299

  • 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.

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