Advertisement

Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Preprocedural Assessment for Patients Anticipating Sedation

Abstract

Purpose of Review

The purpose of this review is to provide a summary of the recent literature addressing the aims, content, outcomes and quality metrics for presedation evaluation.

Recent Findings

There is a trend towards multidisciplinary development of minimum standards for sedation practice, including presedation assessment. A risk-based paradigm underpins presedation assessment. Improved and validated risk scores are required, especially to predict airway difficulty. There is an increasing focus on skillsets rather than roles. Clinicians should explain the intended depth of sedation, how that may be experienced by patients and how patient preferences for sedation can be incorporated into decision-making.

Summary

High-quality presedation evaluation will improve the value of sedation care by aligning appropriate resources (including sedation provider), based on patient risk, and also by improving communication and decision-making.

This is a preview of subscription content, log in to check access.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.

    Fleischer LA. Preoperative cardiac evaluation before noncardiac surgery. Anesthesiology. 2018;129(5):867–8.

  2. 2.

    Ziabari Y, Wigmore T, Kasivisvanathan R. The multidisciplinary team approach for high-risk and major cancer surgery. Br J Anaesth Educ. 2017;17(8):255–61.

  3. 3.

    Sutherland JR, Ludbrook GL. Preadmission processes and opportunities for improvement. Anaesth Intensive Care. 2013;41:427–8.

  4. 4.

    •• 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. Br J Anaesth. 2018;120(1):164–72 Describes a consensus-based standardized tool intended to be used internationally for all types of sedation providers for outcome data collection.

  5. 5.

    • Horeczko T, Mahmoud MA. The sedation mindset: philosophy, science and practice. Curr Opin Anesthesiol. 2016;29(suppl 1):S48–55 Emphasizes targeted presedation assessment and clear explicit communication.

  6. 6.

    •• American Society of Anesthesiologists practice guidelines for moderate procedural sedation and analgesia 2018. Anesthesiology. 2018; 128: 437–79 Most recent update by multidisciplinary consensus, including presedation assessment, and emphasis on airway knowledge and skills.

  7. 7.

    American College of Emergency Physicians Policy Statement. Unscheduled procedural sedation: a multidisciplinary consensus practice guideline. 2018 https://www.acep.org/patient-care/policy-statements/unscheduled-procedural-sedation-a-multidisciplinary-consensus-practice-guideline/

  8. 8.

    Sedation, analgesia and anaesthesia in the radiology department. Second edition. 2018 www.rcr.ac.uk

  9. 9.

    Early DS, Lightdale JR, Vargo JJ, Acosta RD, Chandrasekhara V, et al. Guidelines for sedation and anesthesia in GI endoscopy. Gastrointest Endosc. 2018;87(2):327–37.

  10. 10.

    Coté CJ, Wilson S. American Academy of Pediatrics, American Academy of Pediatric Dentistry. Guidelines for monitoring and management of pediatric patients before, during, and after sedation for diagnostic and therapeutic procedures: update 2016. Pediatrics. 2016;138(1):e20161212.

  11. 11.

    •• NSW Agency for Clinical Innovation. Minimum standards for safe procedural sedation. 2015 https://www.aci.health.nsw.gov.au/__data/assets/pdf_file/0006/218580/Minimum_Standards_for_Safe_Procedural_Sedation_Project_-_Final_-_updated_June_2015.PDFMinimum standards for safe procedural sedation, developed with multidisciplinary input, with focus on risk-based presedation assessment, including red flags for escalation and emphasis on alignment of patient risk with provider skillset.

  12. 12.

    Obara K, Haruma K, Irisawa A, Kaise M, Gotoda T, Sugiyama M, et al. Guidelines for sedation in gastroenterological endoscopy. Dig Endosc. 2015;27:435–49.

  13. 13.

    • Thomas SP, Thakkar J, Kovoor P, Thiagalingham A, Ross D, et al. CSANZ position statement on sedation for cardiovascular procedures (2014). Heart, Lung Circ. 2015;24:1041–8 Highlights risk-based assessment prior to sedation for cardiac procedures.

  14. 14.

    •• Australian and New Zealand College of Anaesthetists Guidelines on sedation and/or analgesia for diagnostic and interventional medical, dental or surgical procedures PS09 2014 https://www.anzca.edu.au/documents/ps09-2014-guidelines-on-sedation-and-or-analgesiaMost recent update of a longstanding multidisciplinary consensus guideline.

  15. 15.

    Conway A, Rolley J, Page K, Fulbrook P. Clinical practice guidelines for nurse-administered procedural sedation and analgesia in the cardiac catheterization laboratory: a modified Delphi study. J Adv Nurs. 2014;70(5):1040–53.

  16. 16.

    •• Sneyd R, et al. Academy of Medical Royal Colleges: Safe Sedation Practice for Healthcare Procedures—standards and guidance October 2013 https://www.aomrc.org.uk/wp-content/uploads/2016/05/Safe_Sedation_Practice_1213.pdfUK multidisciplinary guideline defining fundamental and developing standards in safe sedation practice, and competency-based training for sedation providers.

  17. 17.

    National Institute for Health and Care Excellence. NICE Sedation in under 19s: using sedation for diagnostic and therapeutic procedures. Clinical Guideline CG112 https://www.nice.org.uk/Guidance/CG112

  18. 18.

    Qaseem A, Forland F, Macbeth F, Ollenschläger G, Phillips S, van der Wees P, et al. Guidelines international network: towards international standards for clinical practice guidelines. Ann Intern Med. 2012;156(7):525–31.

  19. 19.

    Montori VM, Brito JP, Murad MH. The optimal practice of evidence based medicine: incorporating patient preferences in practice guidelines. JAMA. 2013;310(23):2503–4.

  20. 20.

    Armstrong MJ, Rueda J-D, Gronseth GS, Mullins CD. Framework for enhancing clinical practice guidelines through continuous patient engagement. Health Expect. 2016;20:3–10.

  21. 21.

    Armstrong MJ, Bloom JA. Patient involvement in guidelines is poor five years after institute of medicine standards: review of guideline methodologies. Res Involv Engag. 2017; 3(19).

  22. 22.

    Srinivasan M, Bhaskar S. Variation in procedural sedation practices among children’s hospitals. Hospital Pediatrics. 2015 www.hospitalpediatrics.org. https://doi.org/10.1542/hpeds.2014-0090.

  23. 23.

    Sappenfield JW, White JD. Do we really need an anesthesiologist for routine colonoscopy in American society anesthesiologist 1 and 2 patients? Curr Opin Anesthesiol. 2018;31:463–8.

  24. 24.

    O’Connor AM, Llewellyn-Thomas HA, Flood AB. Modifying unwarranted variations in health care: shared decision making using patient decision aids. Health Aff. 2004. https://doi.org/10.1377/hlthaff.var.63.

  25. 25.

    Chittle MD, Oklu R, Pino RM, He P, Sheridan RM, Martino J, et al. Sedation shared decision-making in ambulatory venous access device placement: effects on patient choice, satisfaction and recovery time. Vasc Med. 2016;21(4):355–60.

  26. 26.

    Coulthard P, Bridgman CM, Gough L, Longman L, Pretty I, et al. Estimating the need for dental sedation 1. The Indicator of Sedation Need (IOSN)- a novel assessment tool. Br Dent J. 2011;211:E10. https://doi.org/10.1038/sj.bdj.2011.725.

  27. 27.

    Madouh M, Tahmassebi JF. Utilising a paediatric version of the indicator of sedation need for children’s dental care: a pilot study. Eur Arch Paediatr Dent. 2016;17:265–70.

  28. 28.

    • Shokouhi B, Kerr B. A review of the indicator of sedation need (IOSN): what is it and how can it be improved? Br Dent J. 2018;224(3):183–8 An example of needs-based assessment tool for determining need for sedation.

  29. 29.

    Zhang K, Yuan Q, Zhu S, Xu D, An Z. Is unsedated colonoscopy gaining ground over sedated colonoscopy? J Natl Med Assoc. 2018;110(2):143–9.

  30. 30.

    Leslie K, Allen ML, Hessian E, Lee AY-S. Survey of anaesthetists’ practice of sedation for gastrointestinal endoscopy. Anaesth Intensive Care. 2016;44(4):491–7.

  31. 31.

    Leslie K, Sgroi J. Sedation for gastrointestinal endoscopy in Australia: what is the same and what is different? Curr Opin Anesthesiol. 2018;31:481–5.

  32. 32.

    Lai XY, Tang XW, Huang XL, Gong W, Zhi FC, et al. Risk factors of pain during colonoscopic examination. J S Med Univ. 2016;37(4):482–7.

  33. 33.

    Gupta M, Beebe TJ, Dunagan KT, Schleck CD, Zinsmeister AR, Talley NJ, et al. Screening for Barrett’s oesophagus: results from a population-based survey. Dig Dis Sci. 2014;59:1831–50.

  34. 34.

    Simopoulos T, Leffler D, Barnett S, Campbell D, Lian SJ, Gill JS. Prospective assessment of pain and comfort in chronic pain patients undergoing interventional pain management procedures. Pain Med. 2018;19:336–47.

  35. 35.

    Hole J, Hirsch M, Ball E, Meads C. Music as an aid for postoperative recovery in adults: a systematic review and meta-analysis. Lancet. 2015;386:1659–71.

  36. 36.

    Bashiri M, Akçali D, Coşkun D, Cindoruk M, Dikmen A, et al. Evaluation of pain and patient satisfaction by music therapy in patients with endoscopy/colonoscopy. Turk J Gastroenterol. 2018;29(5):574–9.

  37. 37.

    Graff V, Cai L, Badiola I, Elkassabany NM. Music versus midazolam during preoperative nerve block placements: a prospective randomized controlled study. Reg Anesth Pain Med. 2019;44:796–9.

  38. 38.

    Tetzlaff JE, Maurer WE. Preprocedural assessment for sedation in gastrointestinal endoscopy. Gastrointest Endosc Clin N Am. 2016;26:433–41.

  39. 39.

    Harris ZP, Liu J, Saltzman JR. Quality assurance in the endoscopy suite sedation and monitoring. Gastrointest Endosc Clin N Am. 2016;26:553–62.

  40. 40.

    Tobias JD. Sedation of infants and children outside of the operating room. Curr Opin Anesthesiol. 2015;28(4):478–85.

  41. 41.

    Furniss SS, Sneyd JR. Safe sedation in moderate cardiological practice. Heart. 2015;101:1526–30.

  42. 42.

    • Cook TM, Andrade J, Bogod DG, Hitchman JM, Jonker WR, et al. 5th National audit project (NAP5) on accidental awareness during general anaesthesia: patient experiences, human factors, sedation, consent and medicolegal issues. Br J Anaesth. 2014;113(4):560–74 Landmark national audit of accidental awareness, including sedation-related.

  43. 43.

    Pandit JJ, Cook TM, Jonker WR, O’Sullivan E. A national survey of anaesthetists (NAP5 baseline) to estimate an annual incidence of accidental awareness during general anaesthesia in the UK. Anaesthesia. 2013;68:343–53.

  44. 44.

    • Mashour GA, Avidan MS. Intraoperative awareness: controversies and non-controversies. Br J Anaesth. 2015:i20–6 Outlines impact of unexpected patient awareness.

  45. 45.

    Kent CD, Mashour GA, Metzger NA, Posner KL, Domino KB. Psychological impact of unexpected explicit recall of events occurring during surgery performed under sedation, regional anaesthesia and general anaesthesia: data from the anesthesia awareness registry. Br J Anaesth. 2013;110(3):381–7.

  46. 46.

    Saxon C, Fulbrook P, Fong KM, Ski CF. High-risk respiratory patients’ experiences of bronchoscopy with conscious sedation and analgesia: a qualitative study. J Clin Nurs. 2018;27:2740–51.

  47. 47.

    • Conway A. Nurses should inform patients of the possibility of awareness during bronchoscopy performed with procedural sedation. Evid Based Nurs. 2018;21(3):82–3 Highlights importance of explicit communication.

  48. 48.

    Chatman N, Sutherland JR, van der Zwan R, Abraham N. A survey of patient understanding and expectations of sedation/anaesthesia for colonoscopy. Anaesth Intensive Care. 2013;41:369–73.

  49. 49.

    Mak PHK, Campbell RCH, Irwin MG. The ASA physical status classification: inter-observer consistency. Anaesth Intensive Care. 2002;30:633–40.

  50. 50.

    Clough S, Shehabi Z, Morgan C. Medical risk assessment in dentistry: use of the American society of anesthesiologists physical status classification. Br Dent J. 2016;220(3):103–8.

  51. 51.

    Theivanayagam S, Lopez KT, Matteson-Kome ML, Bechtold ML, Asombang AW. ASA classification pre-endoscopic procedures: a retrospective analysis on the accuracy of gastroenterologists. South Med J. 2017;110(2):79–82.

  52. 52.

    Mayhew D, Mendonca V, Murthy BVS. A review of ASA physical status- historical perspectives and modern developments. Anaesthesia. 2019;74:373–9.

  53. 53.

    Aplin S, Baines D, de Lima J. Use of the ASA physical status grading system in pediatric practice. Pediatr Anesth. 2007;17:216–22.

  54. 54.

    Tollinche LE, Yang G, Tan K-S, Borchardt R. Interrater variability in ASA physical status assignment: an analysis in the pediatric cancer setting. J Anaesth. 2018;32:211–8.

  55. 55.

    Keay L, Lindsley K, Tielsch J, Katz J, Schein O. Routine preoperative medical testing for cataract surgery (review). Cochrane Database Syst Rev. 2019;(1):CD007293.

  56. 56.

    O’Neill F, Carter E, Pink N, Smith I. Routine preoperative tests for elective surgery: summary of updated NICE guidance. BMJ. 2016;353:i3292.

  57. 57.

    Martin SK, Cifu AS. Routine preoperative laboratory tests for elective surgery. JAMA. 2017;318(6):567–8.

  58. 58.

    Hollman C, Fernandes NL, Biccard BM. A systematic review of outcomes associated with withholding or continuing angiotensin-converting enzyme inhibitors and angiotensin receptor blockers before noncardiac surgery. Anesth Analg. 2018;127(3):678–87.

  59. 59.

    Roshanov PS, Rochwerg B, Patel A, Salehian O, Duceppe E, Belley-Côté EP, et al. Withholding versus continuing angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers before noncardiac surgery. Anesthesiology. 2017;126:16–27.

  60. 60.

    •• El-Boghdadly K, Aziz MF. Facemask ventilation: the neglected essentials? Anaesthesia. 2019;74:2217–30 Editorial summarising the current state of knowledge and challenges in predicting, managing and rescuing difficult or failed facemask ventilation.

  61. 61.

    Behrens A, Kreuzmayr A, Manner H, Koop H, Lorenz A, et al. Acute sedation-associated complications in GI endoscopy (ProSed 2 study): results from the prospective multicentre electronic registry of sedation-associated complications. Gut. 2019;68:445–52.

  62. 62.

    Rosenburg MB, Phero JC. Airway assessment for office sedation/anesthesia. Anesth Prog. 2015;62:74–80.

  63. 63.

    Langeron O, Masso E, Huraux C, Guggiari M, Bianchi A, Coriat P, et al. Prediction of difficult mask ventilation. Anesthesiology. 2000;92:1229–36.

  64. 64.

    Cattano D, Killoran PV, Cai C, Katsiampoura AD, Corso RM, et al. Difficult mask ventilation in general surgical population: observation of risk factors and predictors. F1000. Research. 2014;3:204.

  65. 65.

    Leoni A, Arlati S, Ghisi D, Verwej M, Lugani D, Ghisi P, et al. Difficult mask ventilation in obese patients: analysis of predictive factors. Minerva Anestesiol. 2014;80(2):149–57.

  66. 66.

    Lundstrøm LH, Rosenstock CV, Wetterslev J, Nørskov AK. The DIFFMASK score for predicting difficult facemask ventilation: a cohort study of 46,804 patients. Anaesthesia. 2019;74:1267–76.

  67. 67.

    Gooden CK, Frost EAM. Preprocedural evaluation: considerations outside of the operating room. Curr Opin Anesthesiol. 2015;28:441–5.

  68. 68.

    Grant C, Ludbrook GL, O’Loughlin EJ, Corcoran TJ. An analysis of computer-assisted pre-screening prior to elective surgery. Anaesth Intensive Care. 2012;40:297–304.

  69. 69.

    Trost MJ, Cowell M, Cannon J, Mitchell K, Waloff K, et al. Risk factors for overnight respiratory events following sedation for magnetic resonance imaging in children with sleep apnea. Sleep Breath Physiol Disord. 2017;21:137–41.

Download references

Author information

Correspondence to Joanna R. Sutherland.

Ethics declarations

Conflict of Interest

Joanna R. Sutherland served as Chair of the working party that developed the Minimum Standards for safe procedural sedation, NSW Agency for Clinical Innovation, which is quoted within this article.

Aaron Conway declares that he has no conflict of interest.

Erica L. Sanderson declares that she has no conflict of interest.

Human and Animal Rights

All reported studies or experiments with human or animal subjects performed by the authors have been previously published and complied with all applicable ethical standards (including the Helsinki declaration and its amendments, institutional/national research committee standards and international/national/institutional guidelines.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Preoperative Evaluation

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Sutherland, J.R., Conway, A. & Sanderson, E.L. Preprocedural Assessment for Patients Anticipating Sedation. Curr Anesthesiol Rep 10, 35–42 (2020). https://doi.org/10.1007/s40140-020-00368-8

Download citation

Keywords

  • Presedation assessment
  • Preprocedural assessment
  • Sedation risk management
  • Shared decision-making