Clinical Assessment
It is essential that a clinical assessment is made to identify patients who:
- Have a ASA classification of unstable class III or class IV and above
- May be difficult to ventilate
This assessment should include a past medical history, drug history and focussed clinical examination to identify any existing medical illnesses, particularly cardiovascular or respiratory disease and allergy.
Prior to performing procedural sedation the patient must undergo a focused clinical assessment.
A specific assessment of the airway should be made and the presence of any anatomic features that may affect airway management should be noted.
Using the Lemon airway assessment method a normal patient should be able to accomodate the following:
- Three finger breadths between the incisors
- Three fingers from the tip of the chin to the neck
- Two fingers from the chin/neck junction to the thyroid cartilage
The presence of any anatomic features that may affectairway management should be noted carefully [2].
Sedation of patients with an increased risk of adverse events requires a greater level of experience and training. Consider the urgency of the situation and whether a general anaesthetic delivered in an anaesthetic room is more appropriate.
Practitioners should always ask themselves beforehand: Will I be able to ventilate this patient, if necessary? [3]