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Moderate and Deep Sedation Techniques

  • John PawlowskiEmail author
Chapter

Abstract

This chapter describes the techniques of moderate sedation and deep sedation. Specific requirements are outlined as to the necessary space, equipment, and assessments needed to provide a safe and effective anesthetic. The anesthetic drugs are listed and described, with particular attention to the useful pharmacologic actions of specific sedatives and the value of short-acting and “soft” drugs. Many common side effects and clinical problems that arise from sedation are addressed, as well as reasonable solutions to these issues. Finally, several future directions in sedation techniques are described, including new agents, new delivery systems, advanced monitors, and refined techniques that should be informative to both anesthesia and pulmonary specialists.

Keywords

Respiratory Depression Ethylene Diamine Tetraacetic Acid Ethylene Diamine Tetraacetic Acid Deep Sedation Bispectral Index 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Suggested Reading

  1. 1.
    Aldrete JA. Post-anesthesia recovery score. J Am Coll Surg. 2007;205:e3–4.PubMedCrossRefGoogle Scholar
  2. 2.
    Egan TD. Is anesthesiology going soft? Trends in fragile pharmacology. Anesthesiology. 2009;111:229–30.PubMedCrossRefGoogle Scholar
  3. 3.
    Fudickar A, Bein B, Tonner PH. Propofol infusion syndrome in anaesthesia and intensive care medicine. Curr Opin Anaesthesiol. 2006;19(4):404–10.PubMedCrossRefGoogle Scholar
  4. 4.
    Glass PS, Gan TJ, Howell S. A review of the pharmacokinetics and pharmacodynamics of remifentanil. Anesth Analg. 1999;89:S7–14.PubMedCrossRefGoogle Scholar
  5. 5.
    Kane GC, Hoehn SM, Behrenbeck TR, Mulvagh SL. Benzocaine-induced methemoglobinemia based on the Mayo Clinic experience from 28,478 transesophageal echocardiograms: incidence, outcomes, and predisposing factors. Arch Intern Med. 2007;167:1977–82.PubMedCrossRefGoogle Scholar
  6. 6.
    Kim K-M. First step to safe anesthesia: pre-operative prediction of difficult airway. Kor Anesth Soc J. 2009;57(3):275–6.CrossRefGoogle Scholar
  7. 7.
    Lightdale JR, Goldmann DA, Feldman HA, et al. Microstream capnography improves patient monitoring during moderate sedation: a randomized- controlled trial. Pediatrics. 2006;117:e1170–8.PubMedCrossRefGoogle Scholar
  8. 8.
    Matot I, Kramer MR. Sedation in outpatient bronchoscopy. Respir Med. 2000;94:1145–53.PubMedCrossRefGoogle Scholar
  9. 9.
    Samsoon GL, Young JR. Difficult tracheal intubation: a retrospective study. Anaesthesia. 1987;42:487–90.PubMedCrossRefGoogle Scholar
  10. 10.
    Schreiber F. Guideline on sedation and monitoring during gastrointestinal endoscopy. Endoscopy. 2007;39:259–62.PubMedCrossRefGoogle Scholar
  11. 11.
    Scott LJ, Perry CM. Remifentanil: A review of its use during the induction and maintenance of general anesthesia. Adis Drug Eval. 2005;65:1793–823.CrossRefGoogle Scholar
  12. 12.
    Smith CM, Stead RJ. Survey of flexible fiberoptic bronchoscopy in the United Kingdom. Eur Respir J. 2002;19:458–63.CrossRefGoogle Scholar
  13. 13.
    Upton RN, Martinez AM, Grant C. Comparison of the sedative properties of CNS 7056, midozolam, and propofol in sheep. Br J Anaesth. 2009;103:848–57.PubMedCrossRefGoogle Scholar
  14. 14.
    Weaver CS, Hauter WH, Duncan CE, et al. An assessment of the association of bispectral index with 2 clinical sedation scales for monitoring depth of procedural sedation. Am J Emerg Med. 2007;25:918–24.PubMedCrossRefGoogle Scholar
  15. 15.
    Williams KA, Barker GL, Harwood RJ, Woodall NM. Combined nebulization and spray-as-you-go topical local anaesthesia of the airway. Br J Anaesth. 2005;95:549–53.PubMedCrossRefGoogle Scholar
  16. 16.
    Yavas S, Lizdas D, Gravenstein N, Lampotang S. Interactive web simulation for propofol and fospropofol, a new propofol prodrug. Anesth Analg. 2008;106:880–3.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Thoracic Anesthesia Beth Israel Deaconess Medical CenterBostonUSA

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