Practice Guidelines for Moderate Procedural Sedation

Dr. Carlos Chacon

January 27, 2023


The practice guidelines for moderate procedural sedation are standards that should be followed for the safety of the patient, the physician, and the patient’s family during a procedure. These guidelines provide specific recommendations for pre-procedure and post-procedure monitoring of the patient during the procedure.

Pre-procedure instructions

Procedural sedation (PSA) is a medical procedure performed on a patient to relieve pain or reduce anxiety. It is an alternative to general anesthesia for certain procedures.

PSA is best performed in a simulation environment. A trained APRN, physician, or nurse monitors the patient during the procedure. They monitor vital signs, oxygen saturation, heart rate, and medications.

A trained Monitoring Assistant is also present during the procedure. This individual is an RN, PA, or MD. They are responsible for airway management and resuscitation equipment. However, they are not permitted to perform other tasks during the procedure.

Before administering procedural sedation, the patient’s medical history and status should be reviewed. The pre-procedure evaluation should include a thorough physical examination of the patient’s airway, a review of consultations, allergies, current medications, and surgical history.

Pre-procedure examination

Procedural sedation is a technique that can be used to increase the effectiveness of procedures. It helps patients feel more relaxed and reduces their apprehension. Sedation is also used in the emergency department to control pain. However, it does not eliminate risks.

Typical pre-procedure evaluation includes an assessment of the patient’s medical condition. The exam should include a detailed history and physical examination. Any current medications, allergies, and laboratory reports should also be reviewed.

Pre-procedure monitoring is essential to ensure the safety of the procedure. This involves observing the patient’s vital signs, including blood pressure and heart rate. Monitoring equipment should include a pulse oximeter and auscultation.

Pre-procedure monitoring criteria

Pre-procedure monitoring criteria for moderate procedural sedation are designed to facilitate safe discharge and minimize adverse effects. Monitoring includes observation and auscultation. The goal is to monitor the patient’s vital signs until the effects of sedation subside.

Before performing a sedation procedure, the responsible physician must assess the patient’s physical status, airway, and response to pre-procedure medications. A focused physical examination of the airway is advisable. If the patient has difficulty breathing, consultation with an anesthesiologist is recommended.

The pre-procedure assessment should be documented in the sedation record. It should include a review of the patient’s medical history, current medications, allergies, and surgical history.

Postprocedural monitoring in the procedure room

Procedural sedation (PS) is a technique for surgical procedures’ safe and effective performance. It is primarily used for noninvasive procedures. PS aims to control pain and minimize patient discomfort. However, there are some risks associated with the procedure. Hence, adequate monitoring is essential.

During the sedation process, the patient’s vital signs are monitored. This includes heart rate, oxygen saturation, and blood pressure. In addition, respiratory rate, auscultation, capnography, and other parameters should also be evaluated.

Observation of the patient’s responses to treatment is performed using the Observer’s Assessment and Alertness/Sedation (OAA/S) scale. The OAA/S score is a qualitative assessment of the patient’s responses.

Deep sedation-qualified physician

Deep sedation is a procedure involving the administration of a deep sedative, a medication that binds to nerves and does not respond to repeated stimuli. This type of sedation is used in patients who cannot be aroused easily or have too great pain.

The patient’s level of consciousness should be assessed before the procedure, during the initial recovery, and at the time of discharge. In addition, monitoring the respiratory rate, heart rate, and oxygen saturation should be performed during the procedure.

For a procedure requiring moderate sedation, supplemental oxygen should be given if hypoxemia is anticipated. Continuous end-tidal CO2 monitoring should be performed for a procedure requiring deep sedation.

Emergency department procedural sedation

Procedural sedation has been an established treatment option in emergency departments for decades. This is a particularly important use of sedation in an ED, as patients may have multiple urgent interventions. Despite this, there is no single, universally accepted sedation protocol. Procedural sedation policies in the US vary widely between hospitals and institutions.

Several recent studies have shown that while sedation effectively provides analgesia, it is not without risks. The most notable adverse events include respiratory depression, hypotension, bradycardia, and oxygen desaturation. Fortunately, most of these are rare.

Nonetheless, the most significant adverse event may not be the most commonly reported complication. Some EDs have adopted conservative measures to ensure regulatory compliance. For example, they limit the use of a specific drug or class of drugs.