Chapter 37: Procedural Sedation

INTRODUCTION

Procedural sedation is the administration of sedatives or dissociative anesthetics to induce a depressed level of consciousness while maintaining cardiorespiratory function so that a medical procedure can be performed with little or no patient reaction or memory.¹ Procedural sedation and analgesia is the addition of agents to reduce or eliminate pain.¹ Levels of sedation are defined by the patient's level of responsiveness and cardiopulmonary function, not by the agents used (Table 37-1).² By definition, patients receiving procedural sedation do not require routine airway protection with endotracheal intubation or other airway adjuncts, as opposed to general anesthesia, which typically requires airway protection. Procedural sedation is commonly done for scheduled outpatient medical procedures by nonanesthesiologists^3,4 and is an accepted technique in emergency medicine.^5,6,7,8 Procedural sedation performed in the ED presents different issues to the practitioner than scheduled outpatient sedation (Table 37-2).^1,7,8

SEDATION LEVEL

There are several key principles that must be followed to safely perform procedural sedation and analgesia (Table 37-3).^1,2,7,8 Despite careful planning and performance, the depth of sedation needed or achieved cannot always be predicted. It is therefore important to prepare for managing deeper levels of sedation than anticipated. Most of the agents used can produce variable levels of sedation, so pay particular attention to dosing and to the patient's responses to the medications.

Minimal sedation is characterized by anxiolysis but with normal, although sometimes slowed, response to ...