Sedation Administration

Types of Sedation	Levels & Definitions
Example of Procedures	Sources

Mission Statement:

All endoscopy nurses, regardless of the setting they work in, should have fundamental skills and knowledge when caring for patients undergoing various types of sedation. The information and guidelines that follow are meant to serve as a comprehensive resource guide and should therefore not be viewed as a substitute for current sedation clinical practice policy or protocols at a nurse’s respective work environment. Every attempt has been made to provide you with the most up-to-date, evidence-based practice information to care for your patients receiving sedation in endoscopy.

The goals of this site are to provide key information dedicated to help improve the success of endoscopic procedures with safe and effective administration of sedatives and analgesics, and to educate on sustaining sedation levels, matching proper agents to patients and procedures, as well as ensuring overall excellence in nurse-administered anesthesia care.

After reviewing the GI Nurse Sedation website, participants will be able to:

1. List common medications for endoscopic sedation.
2. Discuss dosing and warnings for common endoscopic sedation medications.
3. Discuss safe and effective administration of sedatives and analgesics.
4. Explain effective patient sedation and safety throughout the continuum of care.
5. Discuss special care for specific patient populations, such as the pregnant population.
6. Discuss state regulations for the delivery of quality patient care and endoscopic sedation.

The primary options a patient has for intravenous (IV) sedation during gastroenterological procedures include:

Mild Sedation and Moderate Sedation

• Breathing takes place independently
• The patient remains responsive to stimuli
• This form of sedation can be administered and monitored by a trained and certified endoscopy nurse or anesthesia personnel
• Training in the administration of moderate sedation should include opportunities for the trainee to observe an expert performing the administration of sedation followed by a period of mentor-supervised practice in selecting doses and performing patient assessment

Monitored Anesthesia Care (MAC)

• This type of anesthesia service can cover the full range of sedation levels including general anesthesia
• The service includes all aspects of anesthesia care including pre-procedure visit, intra-procedure care, and post-procedure anesthesia management
• MAC is indicated for some patients based on the nature of the procedure they are to undergo, their medical condition, or the potential need to covert to general anesthesia during the procedure
• MAC differs from moderate sedation in that it is provided by an anesthesiologist or certified registered nurse anesthetist who makes an assessment in advance of the actual or potential medical problems that may occur during the procedure
• The person providing MAC must be qualified to convert to general anesthesia when necessary and to rescue the patient’s airway in the event of complications

General anesthesia

• Is a state of total unconsciousness resulting from general anesthetic drugs
• A variety of drugs are given to patients that have different effects with the overall aim of ensuring one or all of the following: unconsciousness, amnesia, analgesia and paralysis
• This type of sedation suppresses the patient’s ability to breathe independently and he or she is not arousable during the procedure
• General anesthesia requires the presence of an anesthesiologist or certified registered nurse anesthetist

Examples of procedures that may or may not require various types of sedation

Indications for Analgesia and Sedation:

Type of Procedure: Rigid and flexible (i.e. proctosigmoidoscopy; rectal endosonography)
Level of Sedation: Sedation is not routinely required. (Moderate sedation optional for anxious patients, anticipation of pain, or therapeutic procedures)

Type of Procedure:Diagnostic and uncomplicated upperendoscopies and colonoscopies
Level of Sedation: Moderate sedation required 

Type of Procedure:Prolonged or complex procedures (i.e. ERCP, endosonography)
Level of Sedation:Deeper levels of sedation may be required

Sedation Levels & Definitions

Sedation and analgesia include a continuum of states of consciousness ranging from minimal sedation (anxiolysis) to general anesthesia. Shown below are the definitions of levels of sedation as defined and adopted by the American Society of Anesthesiologists (ASA).

Sources

Committee of Origin: Ad Hoc on Non-Anesthesiologist Privileging (Approved by the ASA House of Delegates on October 20, 2010) Granting Privileges for Administration of Moderate Sedation to Practitioners Who Are Not Anesthesia Professionals, Statement on (2011). Retrieved from: http://www.asahq.org/For-Members/Standards-Guidelines-and-Statements.aspx

Cohen, L.B., DeLegge, M.H., Aisenberg, J. et al. (2007). AGA Institute Review of Endoscopic Sedation, Gastroenterology, 133:675-701.

Drossman, D.A., Shaheen, N.J., Grimm, I.S. (2005). Handbook of Gastroenterologic Procedures, 4th ed. Philadelphia, PA: Lippincott Williams & Wilkins, 14.

Fanti, L. Testoni, P.A. (2010). Sedation and analgesia in gastrointestinal endoscopy. World Journal Gastroenterology. (16) 20, 2451-2457.

American Society of Anesthesiologists. (2011). Granting Privileges for Administration of Moderate Sedation to Practitioners Who Are Not Anesthesia Professionals, Statement on (2011). Retrieved from http://www.asahq.org/For-Members/Standards-Guidelines-and-Statements.aspx