European Society of Anaesthesiology and European Board of Anaesthesiology guidelines for procedural sedation and analgesia in adults

Abstract

: Procedural sedation and analgesia (PSA) has become a widespread practice given the increasing demand to relieve anxiety, discomfort and pain during invasive diagnostic and therapeutic procedures. The role of, and credentialing required by, anaesthesiologists and practitioners performing PSA has been debated for years in different guidelines. For this reason, the European Society of Anaesthesiology (ESA) and the European Board of Anaesthesiology have created a taskforce of experts that has been assigned to create an evidence-based guideline and, whenever the evidence was weak, a consensus amongst experts on: the evaluation of adult patients undergoing PSA, the role and competences required for the clinicians to safely perform PSA, the commonly used drugs for PSA, the adverse events that PSA can lead to, the minimum monitoring requirements and post-procedure discharge criteria. A search of the literature from 2003 to 2016 was performed by a professional librarian and the retrieved articles were analysed to allow a critical appraisal according to the Grading of Recommendations Assessment, Development and Evaluation method. The Taskforce selected 2248 articles. Where there was insufficiently clear and concordant evidence on a topic, the Rand Appropriateness Method with three rounds of Delphi voting was used to obtain the highest level of consensus among the taskforce experts.These guidelines contain recommendations on PSA in the adult population. It does not address sedation performed in the ICU or in children and it does not aim to provide a legal statement on how PSA should be performed and by whom. The National Societies of Anaesthesiology and Ministries of Health should use this evidence-based document to help decision-making on how PSA should be performed in their countries. The final draft of the document was available to ESA members via the website for 4 weeks with the facility for them to upload their comments. Comments and suggestions of individual members and national Societies were considered and the guidelines were amended accordingly. The ESA guidelines Committee and ESA board finally approved and ratified it before publication.

Клинические Аспекты Процедурной И Послеоперационной Седации

“…Однако даже при адекватно проводимой ПАС существуют определенные риски развития осложнений и даже фатальных исходов [3].…”

“…Основные проблемы, возникающие у пациентов, которым проводится ПАС, зачастую связаны с развитием гипоксии (снижение уровня SpO 2 ), которая регистрируется в 40,2 % случаев, рвоты и аспирации (17,4 % случаев), артериальной гипотензией, гемодинамической нестабильностью (15,2 % случаев) и апноэ (12,4 % случаев) [3].…”

“…Учитывая подобные факты, Совместная комиссия по аккредитации организации здравоохранения США (Joint Commission on Accreditation of Healthcare Organizations) издала указ, по которому ПАС в любом учреждении Соединенных Штатов Америки должна проводиться только квалифицированным анестезиологом [3].…”

Importance of pharmacology to avoid complications with endoscopic sedation

“…Behrens et al 1 refer that propofol was associated with a lower risk of complication (OR 0.75) than midazolam (OR 1), a difference that may be partially explained by the pharmacological profile of drugs since propofol infusion has a faster and shorter action than midazolam, allowing an easier dose titration to avoid accidental overdoses and consequent respiratory failure. Patients with obstructive sleep apnoea (OSA) typically have anatomical defects and/or a narrowed upper airways and, when GABAergic drugs induce muscular hypotonia, are more prone to have inspiratory collapse of the upper airway and consequent obstructive apnoea 2. Additionally, we must be aware that often it is difficult to place in these patients a tracheal tube to control ventilation.…”

“…It has been observed in paediatric ICU sedation that dexmedetomidine (α2A adrenergic agonist) has sedative, analgesic and anaesthetic action with minor interference on the respiratory function 2. Dexmedetomidine in comparison with midazolam may induce a more profound state of sedation with a better respiratory stability, with equal or higher rate of bradycardia and hypotension 3 4.…”