Monitoring and delivery of sedation

Abstract

Sedation for medical procedures is provided in a variety of clinical settings by medical personnel with differing levels of education and training. Although generally a safe practice, there is a degree of morbidity and mortality associated with sedation practice. Monitoring standards continue to be refined by professional societies with the goal of improving care. The depth of sedation should be monitored with clinical criteria. Processed electroencephalographic monitors currently do not contribute significantly to sedation care. Monitoring ventilation using pulse oximetry should be abandoned for more direct methods, such as capnography-transcutaneous carbon dioxide, respiratory acoustical and thoracic impedance monitoring could also play a role. Propofol has become widely utilized for sedation, although there are concerns about its margin of safety and synergistic interactions with other agents. Dexmedetomidine and propofol/ketamine also have utility. Patient-controlled sedation pumps and target-controlled infusion devices have been developed to improve patient care and satisfaction. A computer-assisted propofol sedation device to be used by non-anaesthesiologists has been approved in the USA by the Food and Drug Administration. More computer-assisted sedation delivery devices are likely to be developed, but their clinical utility is unclear.

A systematic review of capnography for sedation

“…Capnography, therefore, should be evaluated rigorously to determine the harm and benefit it causes sedated patients . Our primary objective was to determine whether capnography reduces hypoxaemia in comparison with standard monitoring for sedated patients.…”

Dexmedetomidine and Midazolam Sedation Reduces Unexpected Patient Movement During Dental Surgery Compared With Propofol and Midazolam Sedation

“…Therefore, during dental and surgical treatment under intravenous sedation, it is important not only to prevent aspiration but also to minimize unexpected patient movement or cough reflex. Although anesthetic complications, such as airway obstruction or respiratory depression, can be identified with appropriate patient monitoring, 9 it can be far more difficult to predict unwanted patient movement.…”

Definitions of anaesthetic technique and the implications for clinical research

“…Depth of anaesthesia monitors, for example, those based on processed electroencephalogram or entropy, has been applied to this problem. A positive correlation with clinical sedation scores has consistently been demonstrated [7], but precision is limited by wide inter-individual and interagent variability. There are no specific values on any of the scales which reliably predict level of sedation, or the transition for consciousness to unconsciousness, in a given individual [8,9].…”