CHALLENGES IN PROCEDURAL SEDATION AND ANALGESIA

ANESTHESIA OUTSIDE THE OPERATING ROOM

  • Šćepan Sinanović High Medical College of Professional Studies “Milutin Milanković”, Belgrade https://orcid.org/0000-0002-8125-7873
  • Tanja Prodović High Medical College of Professional Studies “Milutin Milanković”, Belgrade
  • Olivera Milovanović Faculty of Medical Sciencies, University of Kragujevac https://orcid.org/0000-0002-5593-0526
  • Saša Bubanj University of Niš, Faculty of Sport and Physical Education, Niš, Serbia https://orcid.org/0000-0002-7849-6339
  • Miljan Krstović University Clinical Center Niš, Serbia
  • Srećko Potić High Medical College of Professional Studies “Milutin Milanković”, Belgrade https://orcid.org/0000-0002-4782-4328
  • Jelena Sekulić High Medical College of Professional Studies “Milutin Milanković”, Belgrade
  • Danilo Jeremić
DOI: https://doi.org/10.5937/afmnai40-38674
Ključne reči: procedural sedation and analgesia, monitoring, sedation-related adverse event

Sažetak


There are several definitions given by various anesthesiology professional organizations that explain the term procedural sedation and analgesia (PSA). The International Committee for the Advancement of PSA has defined procedural sedation as the use of anxiolytics, sedatives, hypnotics, analgesics and / or dissociative drugs to alleviate anxiety, pain and / or movement. These agents are used to facilitate the attainment of amnesia or to reduce the consciousness and / or comfort and safety of the patient during diagnostic or therapeutic procedures. The first guidelines for sedation are based on the mandatory signing of informed consent, monitoring and measuring vital parameters, implementing a fasting regimen before sedation, possessing the skills to establish and maintain the airway, and resuscitation measures. Since PSA is most often used outside the operating room, this type of anesthesia activity is known as NORA (Non Operating Room Anesthesia Care). Preprocedural evaluation and preparation, periprocedural management, monitoring and care of postprocedural recovery from PSA is similar to those of general or regional anesthesia.In conclusion, a number of logistical and practical difficulties should be noted, such as the availability of medicines and appropriate staff training, as well as the application of global guidelines on PSA.

Reference


  1. American College of Emergency Physicians. Clinical policy: Procedural sedation and analgesia in the emergency department. Ann Emerg Med 2005; 45: 177-96.

  2. Cravero JP, Blike GT. Review of Pediatric Sedation. Anesth Analg 2004; 99: 1355-64.

  3. Standards Guidelines and Statements-Viewed 3-21-11 Available from: http://www. asahq.org/For-Members/Clinical-Information/Standards-Guidelinesand-Statements.aspx.

  4. Miličić B, Bradić Ž, Kalezić N. Procedural sedation and analgesia. In: Perioperative medicine 1. Kalezić N, editor. Faculty of Medicine, Belgrade, 2020. (Serbian)

  5. Green SM, Irwin MG, Mason KP. Procedural sedation: providing the missing definition. Anaesthesia 2021; 76: 598–601. 

  6. Roback MG, Green SM, Andolfatto G, Leroy PL, Mason KP. Tracking and Reporting Outcomes Of Procedural Sedation (TROOPS): Standardized Quality Improvement and Research Tools from the International Committee for the Advancement of Procedural Sedation. British Journal of Anaesthesia, 120(1): 164e172 (2018)

  7. Wong T, Georgiadis PL, Urman RD, Tsa MH. Non-Operating Room Anesthesia: Patient Selection and Special Considerations. Local and Regional Anesthesia 2020; 13: 1–9.

  8. Hinkelbein J, Schmitz J, Lamperti M, Fuchs-Buder T. Procedural sedation outside the operating room. Current Opinion in Anaesthesiology 2020; 33(4): 533-538.

  9. Vukotić A, Živković A, Petrović P. Deep sedation of pediatric patients using midazolam and ketamine during diagnostics by magnetic resonance imaging in outpatient settings. Timok Medical Gazette.2007; 32 (4): 159-163. (Serbian)

  10. Vasiljević S, Miličić B, Sabljak V, Jozić I, Stojanović M, Marković D. Procedural sedation and analgesia in outpatient with altered liver and renal function. SJAIT 2014; 3-4: 253-259. (Serbian)

  11. Katančić J, Milić M, Goranović T. The importance of anesthesia in the diagnostic examination of endobronchial ultrasound. Acta Med Croatica 2018; 72(1): 99-103. (Serbian)

  12. American Society of Anesthesiologists. Task Force on Sedation and Analgesia by Non-Anesthesiologists. Practice guidelines for sedation and analgesia by non-anesthesiologists. Anesthesiology 2002; 96(4):1004-17.

  13. Gross JB, Bailey PL, Connis RT, et al. Practice guidelines for sedation and analgesia by nonanesthesiologists. Anesthesiology 2002; 96: 1004-17 (29).

  14. Practice Guidelines for Moderate Procedural Sedation and Analgesia 2018: a report by the American Society of Anesthesiologists Task Force on Moderate Procedural Sedation and Analgesia, the American Association of Oral and Maxillofacial Surgeons, American College of Radiology, American Dental Association, American Society of Dentist Anesthesiologists, and Society of Interventional Radiology. Anesthesiology 2018; 128: 437-79.

  15. Roizen MF. Preoperative laboratory testing: What is needed? 54th ASA Annual Refresher Course Lectures. 2003:146.

  16. Kang HS, Hyun LL. Preparation and Patient Evaluation for Safe Gastrointestinal Endoscopy Clin Endosc 2013; 46(3): 212-18.

  17. Veitch AM, Baglin TP, Gershlick AH, Harnden SM, Tighe R, Cairns S. Guidelines for the management of anticoagulant and antiplatelet therapy in patients undergoing endoscopic procedures. Gut 2008; 57: 1322-9.

  18. ASGE Standards of Practice Committee, Anderson MA, Ben-Menachem T, et al. Management of antithrombotic agents for endoscopic procedures. Gastrointest Endosc 2009; 70: 1060-70.

  19. Green SM, Leroy PL, Roback MG, Irwin MG, Andolfatto G, Babl FE, Barbi E, Costa LR, Absalom A, Carlson DW, Krauss BS, Roelofse J, Yuen VM, Alcaino E, Costa PS, Mason KP; International Committee for the Advancement of Procedural Sedation. An international multidisciplinary consensus statement on fasting before procedural sedation in adults and children. Anaesthesia. 2020 Mar;75(3):374-385. doi: 10.1111/anae.14892. Epub 2019 Dec 2. Erratum in: Anaesthesia. 2020 Jun;75(6):818. PMID: 31792941; PMCID: PMC7064977.

  20. Guidelines for non operation room locations. American Society of Anesthesiologist Park Ridge, IL:1997.

  21. Youn YJ, Hyun JK. Sedation Strategies for Procedures Outside the Operating Room. Yonsei Med J 2019; 60(6): 491-499.

  22. Qadeer MA, Vargo JJ, Dumot JA, Lopez R, Trolli PA, Stevens T, et al. Capnographic monitoring of respiratory activity improves safety of sedation for endoscopic cholangiopancreatography and ultrasonography. Gastroenterology 2009; 136:1568–1576.

  23. ASA Committee on Standards and Practice Parameters. Standards for basic anesthetic monitoring [accessed on 2019 January 31]. Available at: https://www.asahq.org/~/media/Sites/ASAHQ/Files/Public/Resources/standards-guidelines/standards-for-basic-anesthetic-monitoring.pdf.

  24. Australian and New Zealand College of Anaesthetists. Guidelines on sedation and/or analgesia for diagnostic and interventional medical, dental or surgical procedures [accessed on 2019 January 31]. Available at: http://www.anzca.edu.au/documents/ps09-2014-guidelines-on-sedation-and-or-analgesia.

  25. Yang KS, Habib AS, Lu M, Branch MS, Muir H, Manberg P, et al. A prospective evaluation of the incidence of adverse events in nurseadministered moderate sedation guided by sedation scores or Bispectral Index. Anesth Analg 2014; 119: 43-8.

  26. Pharmacological Agents for Procedural Sedation and Analgesia in the Emergency Department. The Royal College of Emergency Medicine. Best Practice Guideline, 5, 2016, Available at: www.rcem.ac.uk

  27. Change B, Kaye A, Dize D, et al. Interventional procedures outside of the operating room: results from the national anesthesia clinical outcomes registry. J Patient Saf. 2018; 14(1): 9–16.

  28. Pitchon DN, Dayan AC, Schwenk ES, Baratta JL, Viscusi ER. Updates on multimodal analgesia for orthopedic surgery. Anesthesiol Clin. 2018; 36(3): 361–373.

  29. Beverly A, Kaye AD, Ljunggvist O, Urman RD. Essential elements of multimodal analgesia in enhanced recovery after surgery (ERAS) guildelines. Anesthesiol Clin. 2017; 35(2): e115–e143.

  30. Jo YY, Kwak HJ.   Sedation Strategies for Procedures Outside the Operating Room.   Yonsei Med J. 2019 Jun; 60(6):491-499. https://doi.org/10.3349/ymj.2019.60.6.491.

Objavljeno
2025/12/19
Broj časopisa
Vol. 40 Br. 2 (2023): Acta facultatis medicae Naissensis
Rubrika
Pregledni rad / Review article