Skip to main content
SpringerLink
Log in

Practice Guidelines for Adult Sedation and Analgesia

  • Chapter
Sedation and Analgesia for Diagnostic and Therapeutic Procedures

Part of the book series: Contemporary C Neuroscience ((CCNE))

  • 177 Accesses

Abstract

The goal of sedation and analgesia is to ensure patient comfort and safety and allay anxiety during diagnostic and therapeutic procedures (1). A corollary of improved patient comfort is improved cooperation, and as a result, the enhanced potential for the timely completion of the procedure under optimal conditions. The rapid growth of new technologies has led to the increased use of novel, less invasive approaches to diagnosis and treatment outside the operating room, and many of these require the use of sedation and analgesia for a successful outcome. Anesthesiologists are logically called upon to provide services; however, the volume of procedures in most institutions exceeds the anesthesiologists’ availability because of operating room duties and other commitments (2). This has increasingly led to the provision of sedation services by non-anesthesiologists from a variety of disciplines. The Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) has recognized the need for comparable standards throughout the hospital, suggesting in a sample policy accompanying their standards that sedation policies and procedures “shall be monitored and evaluated by the Department of Anesthesia” (3).

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

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Lind, L. J., and Mushlin, P. S. (1987) Sedation, analgesia and anesthesia for radiologic procedures. Cardiovasc. Interventional Radiol. 10, 247–253.

    Article  CAS  Google Scholar 

  2. Holzman, R. S., Cullen, D. J., Eichhorn, J. H., and Philip, J. H. (1994) Guidelines for Sedation by nonanesthesiologists during diagnostic and therapeutic procedures. J. Clin. Anesth. 6, 265–276.

    Article  PubMed  CAS  Google Scholar 

  3. Joint Commission on Accreditation of Healthcare Organization (JCAHO) 1999 (Jan.) Comprehensive Accreditation Manual for Hospitals: The Official Handbook. Oakbrook Terrace, IL, JCAHO, TX–74.

    Google Scholar 

  4. American Society of Anesthesiologists Task Force, Practice (1996) Guidelines for sedation and analgesia by non-anesthesiologists. Anesthesiology 84(2), 459–471.

    Article  Google Scholar 

  5. American Society for Gastrointestinal Endoscopy (1995) Sedation and monitoring of patients undergoing gastrointestinal endoscopic procedures. Gastrointest. Endosc. 42:6, 626–629.

    Article  Google Scholar 

  6. Iverson, R. E. (1999) Sedation and analgesia in ambulatory settings. American Society of Plastic and Reconstructive Surgeons Task Force on sedation and analgesia in ambulatory settings. Plast. Reconstr. Surg. 104:5, 1559–1564.

    Article  PubMed  CAS  Google Scholar 

  7. American College of Emergency Physicians. (1998) Clinical policy for procedural sedation and analgesia in the emergency department. Ann. Emerg. Med. 31:5, 663–677.

    Article  Google Scholar 

  8. Innes, G., Murphy, M., Nijssen-Jordan, C., Ducharme, J., and Drummond, A. (1999) Procedural sedation and analgesia in the emergency department. Canadian Consensus Guidelines. J. Emerg. Med. 17:1, 145–156.

    Article  PubMed  CAS  Google Scholar 

  9. Association of Operating Room Nurses. (1997) Recommended practices for managing the patient receiving conscious sedation/analgesia. AORN 65:1, 129–134.

    Article  Google Scholar 

  10. Turajek, S. K. (1999) Office based anesthesia standards. American Association of Nurse Anesthetists. AANA J. 67:2, 115–120.

    Google Scholar 

  11. http://www.asahq.org/Standards/20.htm.

    Google Scholar 

  12. Joint Commission on Accreditation of Healthcare Organization (JCAHO) (1999) Accreditation Manual for Hospitals. Oakbrook Terrace, IL, JCAHO, TX–15.

    Google Scholar 

  13. Joint Commission on Accreditation of Healthcare Organization (JCAHO) (1999) Accreditation Manual for Hospitals. Oakbrook Terrace, IL, JCAHO, TX–78.

    Google Scholar 

  14. Iber, F. L., Livak, A., and Kruss, D. M. (1992) Apnea and cardiopulmonary arrest during and after endoscopy. J. Clin. Gastroenterol. 14:2. 109–113.

    Article  PubMed  CAS  Google Scholar 

  15. Bailey, P. L., Pace, N. L., Ashburn, M. A., Moll, J. W., East, K. A., and Stanley, T. H. (1990) Frequent hypoxemia and apnea after sedation with midazolam and fentanyl. Anesthesiology 73:5, 826–830.

    Article  PubMed  CAS  Google Scholar 

  16. Joint Commission on Accreditation of Healthcare Organization (JCAHO) (1999) Accreditation Manual for Hospitals. Oakbrook Terrace, IL, JCAHO, TX-74.

    Google Scholar 

  17. Sugiyama, A., Kaneko, Y., Ichinohe, T., Koyama, T., Sakurai, S., and Nakakuki, T. (1991) Usefulness of the pulse oximeter as a respiratory monitor during intravenous sedation. Bull. Tokyo Dent. Coll. 32:1, 19–26.

    PubMed  CAS  Google Scholar 

  18. Kraut, R. A. (1985) Continuous transcutaneous 0<sub>2</sub> and CO<sub>2</sub> monitoring during conscious sedation for oral surgery. Oral Maxillofac. Surg. 43:7, 489–492.

    Article  CAS  Google Scholar 

  19. Singer, R., and Thomas, P. E. (1988) Pulse oximeter in the ambulatory aesthetic surgical facility. Plast. Reconstr. Surg. 82:1, 111–115.

    PubMed  CAS  Google Scholar 

  20. Newland, C. J., Spiers, S. P., and Finlay, D. B. (1991) Technical report: oxygen saturation monitoring during sedation for chemolysis. Clin. Radiol. 44:5, 352–353.

    Article  PubMed  CAS  Google Scholar 

  21. Murray, A. W., Morran, C. G., Kenny, G. N., and Anderson, J. R. (1990) Arterial oxygen saturation during upper gastrointestinal endoscopy: the effects of a midazolam/pethidine combination. Gut 31:3, 270–273.

    Article  PubMed  CAS  Google Scholar 

  22. McKee, C. C., Ragland, J. J., and Myers, J. O. (1991) An evaluation of multiple clinical variables for hypoxia during colonoscopy. Surg. Gynecol. Obstet. 173:1, 37–40.

    PubMed  CAS  Google Scholar 

  23. Hinmann, C. A., Budden, P. M., and Olsen, J. (1992) Intravenous conscious sedation use in endoscopy: does monitoring of oxygen saturation influence timing of nursing interventions? Gastroenterol. Nurs. 15:1, 6–13.

    Google Scholar 

  24. Schmitt, H. J., Schuetz, W. H., Proeschel, P. A., and Jaklin, C. (1993) Accuracy of pulse oximetry in children with cyanotic congenital heart disease. J. Cardiothorac. Vasc. Anesth. 7:1, 61–65.

    Article  PubMed  CAS  Google Scholar 

  25. Barker, S. J., and Tremper, K. K. (1987) Pulse oximetry: applications and limitations. Int. Anesthesiol. Clin. 25, 155–175.

    Article  PubMed  CAS  Google Scholar 

  26. Severinghaus, J. W., and Naifeh, K. H. (1987) Accuracy of response of six pulse oximeters to profound hypoxia. Anesthesiology 67:4, 551–558.

    Article  PubMed  CAS  Google Scholar 

  27. Dumas, C., Wahr, J. A., and Tremper, K. K. (1996) Clinical evaluation of a prototype motion artifact resistant pulse oximeter in the recovery room. Anesth. Analg. 83:2, 269–272.

    PubMed  CAS  Google Scholar 

  28. Barker, S. J., and Shah, N. K. (1997) The effects of motion on the performance of pulse oximeters in volunteers (revised publication). Anesthesiology 86:1, 101–108.

    Article  PubMed  CAS  Google Scholar 

  29. Iwasaki, J., Vann, W. F., Dilley, D. C., and Anderson, J. A. (1989) An investigation of capnography and pulse oximetry as monitors of pediatric patients sedated for dental treatments. Pediatr. Dent. 11:2, 111–117.

    PubMed  CAS  Google Scholar 

  30. Hayward, S. R., Sugawa, C., and Wilson, R. F. (1989) Changes in oxygenation and pulse rate during endoscopy. Am. Surg. 55:3, 198–202.

    PubMed  CAS  Google Scholar 

  31. Herman, L. L., Kurtz, R. C., McKee, K. J., Sun, M., Thaler, H. T., and Winawer, S. J. (1993) Risk factors associated with vasovagal reactions during colonoscopy. Gastrointest. Endosc. 39:3, 388–391.

    Article  PubMed  CAS  Google Scholar 

  32. Matot, I., Kramer, M. R., Glantz, L., Drenger, B., and Cotev, S. (1997) Myocardial ischemia in sedated patients undergoing fiberoptic bronchoscopy. Chest 112:6, 1454–1458.

    Article  PubMed  CAS  Google Scholar 

  33. Bell, G. D., Quine, A., Antrobus, J. H., Morden, A., Burridge, S. M., Coady, T. J., and Lee, J. (1992) Upper gastrointestional endoscopy: a prospective randomized study comparing continuous supplemental oxygen via the nasal or oral route. Gastrointest. Endosc. 38:3, 319–325.

    Article  PubMed  CAS  Google Scholar 

  34. Haines, D. J., Bibbey, D., and Green, J. R. (1992) Does nasal oxygen reduce the cardiorespiratory problems experienced by elderly patients undergoing endoscopic retrograde cholangiopancreatography? Gut 33:7, 973–975.

    Article  PubMed  CAS  Google Scholar 

  35. Bowling, T. E., Hadjiminas, C. L., Polson, R. J., Baron, J. H., and Foale, R. A. (1993) Effects of supplemental oxygen on cardiac rhythm during upper gastrointestinal endoscopy: a randomised controlled double blind trial. Gut 34:11, 1492–1497.

    Article  PubMed  CAS  Google Scholar 

  36. Gross, J. B., and Long, W. B. (1990) Nasal oxygen alleviates hypoxemia in colonoscopy patients sedated with midazolam and meperidine. Gastrointest. Endosc. 36:1, 26–29.

    Article  PubMed  CAS  Google Scholar 

  37. Hardeman, J. H., Sabol, S. R., and Goldwasser, M. S. (1990) Incidence of hypoxemia in the postanesthetic recovery room in patients having undergone intravenous sedation for outpatient oral surgery. J. Oral Maxillofac. Surg. 48:9, 942–944.

    Article  PubMed  CAS  Google Scholar 

  38. Block, A., Boysen, P., Wynne, J., et al. (1979) Sleep apnea hypopnea and oxygen desaturation in normal subjects: a strong male predominance. N. Engl. J. Med. 300, 513–517.

    Article  PubMed  CAS  Google Scholar 

  39. American College of Emergency Physicians. (1998) Clinical policy for procedural sedation and analgesia in the emergency department. Ann. Emerg. Med. 31:5, 663–677.

    Article  Google Scholar 

  40. Joint Commission on Accreditation of Healthcare Organization (JCAHO) (1999) Accreditation Manual for Hospitals. Oakbrook Terrace, IL, JCAHO, TX–73.

    Google Scholar 

  41. Wright, S., Chudnofsky, C., Dronen, S., et al. (1993) Comparison of midazolam and diazepam for procedural sedation and analgesia in the emergency department. Ann. Emerg. Med. 22, 201–205.

    Article  PubMed  CAS  Google Scholar 

  42. Manninen, P. H., Chan, A. S. H., and Papworth, D. (1997) Conscious sedation for interventional neuroradiology: a comparison of midazolam and propofol infusion. Can. J. Anaesth. 44:1, 26–30.

    Article  PubMed  CAS  Google Scholar 

  43. Etzkorn, K. P., Diab, F., Brown, R. D., Dodda, G., Edelstein, B., Bedford, R., and Venu, R. P. (1998) Endoscopic retrograde cholangiopancreatography under general anesthesia: indications and results. Gastrointest. Endosc. 47:5, 363–367.

    Article  PubMed  CAS  Google Scholar 

  44. Iber, F. L., Sutberry, M., Gupta, R., and Kruss, D. (1998) Evaluation of complications during and after conscious sedation for endoscopy using pulse oximetry. Gastrointest. Endosc. 39:5, 620–625.

    Article  Google Scholar 

  45. Al-Hadeedi, S., and Leaper, D. J. (1991) Falls in hemoglobin saturation during ERCP and upper gastrointestinal endoscopy. World J. Surg. 15:1, 88–94.

    Article  PubMed  CAS  Google Scholar 

  46. Dodson, S. R., Hensley FA, J. r., Martin, D. E., Larach, D. R., and Morris, D. L. (1988) Continuous oxygen saturation monitoring during cardiac catheterization in adults. Chest 94:1, 28–31.

    Article  PubMed  CAS  Google Scholar 

  47. Woods, S. D., Chung, S. C., Leung, J. W., Chan, A. C., and Li, A. K. (1989) Hypoxia and tachycardia during endoscopic retrograde cholangiopancreatography: detection by pulse oximetry. Gastrointest. Endosc. 35:6, 523–525.

    Article  PubMed  CAS  Google Scholar 

  48. O’Connor, K. W., and Jones, S. (1990) Oxygen desaturation is common and clinically underappreciated during elective endoscopic procedures. Gastrointest. Endosc. 36:3, S2–S4.

    PubMed  Google Scholar 

  49. Visco, D. M., Tolpin, E., Straughn, J. C., and Fagraeus, L. (1989) Arterial oxygen saturation in sedated patients undergoing gastrointestinal endoscopy and a review of pulse oximetry. Del. Med. J. 61:10, 533–542.

    PubMed  CAS  Google Scholar 

  50. Reed, M. W., O’Leary, D. P., Duncan, J. L., Majeed, A. W., Wright, B., and Reilly, C. S. (1993) Effects of sedation and supplemental oxygen during upper alimentary tract endoscopy. Scand. J. Gastroenterol. 28:4, 319–322.

    Article  PubMed  CAS  Google Scholar 

  51. Alcain, G., Guillen, P., Escolar, A., Moreno, M., and Martin, L. (1998) Predictive factors of oxygen desaturation during upper gastrointestinal endoscopy in nonsedated patients. Gastrointest. Endosc. 48:2, 143–147.

    Article  PubMed  CAS  Google Scholar 

  52. White, C. S., Dolwick, M. F., Gravenstein, N., and Paulus, D. A. (1989) Incidence of oxygen desaturation during oral surgery outpatient procedures. J. Oral Maxillofac. Surg. 47:2, 147–149.

    Article  PubMed  CAS  Google Scholar 

  53. Putinati, S., Ballerin, L., Corbetta, L., Trevisani, L., and Potena, A. (1999) Patient satisfaction with conscious sedation for bronchoscopy. Chest 115:5, 1437–1440.

    Article  PubMed  CAS  Google Scholar 

  54. Silvis, S. E., Nebel, O., Rogers, G., et al. (1976) Cardiopulmonary complications are more common than bleeding or perforation during diagnostic procedures. JAMA 235, 928–930.

    Article  PubMed  CAS  Google Scholar 

  55. Gilbert, D. A., Silverstein, F. E., Tedesco, F. J., et al. (1981) National ASGE survey on upper gastrointestinal bleeding; complications of endoscopy. Dig. Dis. Sci. 26S, 55–59.

    Article  Google Scholar 

  56. McCloy, R. (1992) Asleep on the job: sedation and monitoring during endoscopy. Scand. J. Gastroenterol. 27S:192, 97–101.

    Article  Google Scholar 

  57. Doctors Day 1999: Patient Safety. (1999) ASA Newsletter 63:2, 13–14.

    Google Scholar 

  58. D’Eramo, E. M. (1999) Mortality and morbidity with outpatient anesthesia: the Massachusetts experience. J. Oral Maxillofac. Surg. 57:5, 531–536.

    Article  PubMed  Google Scholar 

  59. Flick, W. G., Green, J., and Perkins, D. (1998) Illinois dental anesthesia and sedation survey for 1996. Anesth. Prog. 45:2, 51–56.

    PubMed  CAS  Google Scholar 

  60. Jastak, J. T., and Peskin, R. M. (1991) Major morbidity or mortality from office anesthetic procedures: a closed-claim analysis of 13 cases. Anesth. Prog. 38:2, 39–44.

    PubMed  CAS  Google Scholar 

  61. Roseveare, C., Seavell, C., Patel, P., Criswell, J., and Shephard, H. (1998) Patient-controlled sedation with propofol and alfentanil during colonoscopy; a pilot study. Endoscopy 30:5, 482–483.

    Article  PubMed  CAS  Google Scholar 

  62. Heiman, D. R., Tolliver, B. A., Weis, F. R., O’Brien, B. L., and DiPalma, J. A. (1998) Patient-controlled anesthesia for colonoscopy using propofol: results of a pilot study. South. Med. J. 91:6, 560–564.

    Article  PubMed  CAS  Google Scholar 

  63. Kaufman, E., Davidson, E., Sheinkman, Z., and Magora, F. (1994) Comparison between intranasal and intravenous midazolam sedation (with or without patient control) in a dental phobia clinic. J. Oral Maxillofac. Surg. 52:8, 840–843.

    Article  PubMed  CAS  Google Scholar 

  64. Webb, R. K., Van der Walt, J. H., Runciman, W. R., et al. (1993) Which monitor? An analysis of 2000 incident reports. Anesthesiol. and Int. Care 21:5, 529–542.

    CAS  Google Scholar 

  65. Tinker, J. H., Dull, D. L., Caplan, R. A., et al. (1989) Role of monitoring devices in prevention of anesthetic mishaps: a closed claims analysis. Anesthesiology 71, 541–546.

    Article  PubMed  CAS  Google Scholar 

  66. Wright, S. W. (1992) Conscious sedation in the Emergency Department: the value of capnography and pulse oximetry. Ann. Emerg. Med. 21, 551–555.

    Article  PubMed  CAS  Google Scholar 

  67. Shapiro, B. A. (1999) Bispectral index: better information for sedation in the intensive care unit? Crit. Care Med. 27:8, 1663–1664.

    Article  PubMed  CAS  Google Scholar 

  68. Glass, P., Gan, T. J., Sebel, P. S., et al. (1995) Comparison of the Bispectral Index (BIS) and measured drug concentrations for monitoring the effects of propofol, midazolam, alfentanil and isoflurane. Anesthesiology 83S3A, A374.

    Google Scholar 

  69. Shah, N., Clack, S., Tayong, M., et al. (1996) The Bispectral Index of EEG can predict response in intensive care patients. Anesthesiology 85S3A, A281.

    Google Scholar 

  70. Ristikankare, M., Hartikainen, J., Heikkinen, M., and Janatuinen, E. (1999) Is routinely given conscious sedation of benefit during colonoscopy? Gastrointest. Endosc. 49:5, 566–572.

    CAS  Google Scholar 

  71. Fisher, N. C., Bailey, S., and Gibson, J. A. (1998) A prospective, randomized controlled trial of sedation vs. no sedation in outpatient upper gastrointestinal endoscopy. Endoscopy 30:1, 21–24.

    Article  PubMed  CAS  Google Scholar 

  72. Rex, D. K., Imperiale, T. F., and Portish, V. (1999) Patients willing to try colonoscopy without sedation: associated clinical factors and results of a randomized controlled trial. Gastrointest. Endosc. 49:5, 554–559.

    Article  PubMed  CAS  Google Scholar 

  73. Hoffman, M. S., Butler, T. W., and Shaver, T. (1998) Colonoscopy without sedation. J. Clin. Gastroenterol. 26:4, 279–282.

    Article  PubMed  CAS  Google Scholar 

Download references

Authors
  1. Randolph Steadman MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Steve Yun MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Department of Anesthesiology, University of Michigan Health System, Ann Arbor, MI, USA

    Shobha Malviya MD , Norah N. Naughton MD  & Kevin K. Tremper MD, PhD ,  & 

Rights and permissions

Reprints and permissions

Copyright information

© 2003 Springer Science+Business Media New York

About this chapter

Cite this chapter

Steadman, R., Yun, S. (2003). Practice Guidelines for Adult Sedation and Analgesia. In: Malviya, S., Naughton, N.N., Tremper, K.K. (eds) Sedation and Analgesia for Diagnostic and Therapeutic Procedures. Contemporary Clinical Neuroscience. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-59259-295-1_3

Download citation

  • DOI: https://doi.org/10.1007/978-1-59259-295-1_3

  • Publisher Name: Humana Press, Totowa, NJ

  • Print ISBN: 978-1-61737-228-5

  • Online ISBN: 978-1-59259-295-1

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation