The office or outpatient setting as a site for procedures is, metaphorically, a small lifeboat (not a pirate ship!) on the high seas away from port and the mothership, far from immediate aid. Whether the site is a detached procedural area on the campus of a large medical center, or a procedure room in a physician’s office, the metaphor is appropriate. The lifeboat and her crew must be capable and equipped to handle emergencies without immediate help from the outside. At a medical center, even a detached outpatient procedural area may have access to a rapid response team with rescue capabilities. However, such advanced emergency support teams will not be as close as they would be if the procedure were taking place in the main hospital. Help may be even more distant when working at a freestanding outpatient surgical suite or a physician’s office, when the municipal emergency response system (911) must be activated. Therefore, the crew of the lifeboat must be prepared to perform the primary resuscitation as they are the first responders.

Patient evaluation for a sedation procedure may begin with the first telephone contact. When the patient first calls to schedule an appointment, an administrative assistant or scheduler may ask screening questions about age, height and weight, the presence of common comorbid diseases such as diabetes, heart and lung disease, snoring/obstructive sleep apnea, and routine use of narcotics or sedatives. Although clerical staff may not have the clinical education to question in detail or follow up on positive findings, initial screening may help determine which patients are good candidates for sedation and those who are not. Categories of sedation include (1) local with minimal to no sedation, (2) moderate sedation, (3) deep sedation, and (4) sedation administered by an anesthesia provider.