Environment, Equipment and Monitoring

Safe Sedation Procedures in Adults Safe Sedation Practice Environment, Equipment and Monitoring

Sedation should take place within a specifically designated area of the department, i.e. a procedure room or the resuscitation room where oxygen, suction, reversal agents and advance life support equipment is immediately available.

Table 1

Table 1: Minimum levels of equipment
Cardiac monitor	Laryngeal masks
Pulse oximetry	10 ml syringe
BP recording set at 5 minute intervals	Tie
Oxygen applied and delivered prior to procedure	Gloves
Suction	Tourniquet
Tilting trolley	Venflons
Bag, value, mask system ventilation (BVM) – appropriate sized masks	Syringes 5 ml, 10 ml
Selection OP/nasopharyngeal (NP) airways	Flumazenil
ETT size 7,8,9 cuffed	Naloxone
Adjuncts – stylet and gum elastic bougie	Running IV line with 500 ml 0.9% saline
Short and long blade laryngoscopes	Defibrillator and emergency drug box

Minimum monitoring requirements during procedural sedation are heart rate, non-invasive blood pressure, respiratory rate and oxygen saturation. The patients sedation level should also be recorded using a recognised scale such as the ASA classification of grades of conscious depression. [6]

Table 2

Table 2: American Society of Anesthesiologists classification of grades of conscious depression
Level of sedation ————- Parameter	Minimal sedation(anxiolysis)	Moderate sedation(conscious sedation)	Deep sedation	General anaesthesia
Responsiveness	Normal response to verbal stimulation	Purposeful response to verbal or tactile stimulation	Purposeful response after repeated or painful stimulation	Unrousable even with painful stimulus
Airway	Unaffected	No intervention required	Intervention may be required	Intervention often required
Spontaneous ventilation	Unaffected	Adequate	Maybe inadequate	Frequently inadequate
Cardiovascular function	Unaffected	Usually maintained	Usually maintained	Maybe impaired

Sedation should take place within a specifically designated area where oxygen, suction, reversal agents and advance life support equipment is immediately available.

Learning Bite

Minimum monitoring requirements during procedural sedation are heart rate, non-invasive blood pressure, respiratory rate, oxygen saturation and continuous waveform capnography

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