Patient Monitoring During Procedural Sedation: Are the Modern Standards Implemented in Ukraine?

Abstract

The purpose of the study was to review modern recommendations regarding the monitoring of patients during procedural sedation and analgesia as well as to assess its conformity to the modern standards in Ukraine.
 Materials and methods. Recommendations from European, American, British and Australian organizations which cover the topic of procedural sedation and analgesia or levels of anesthesia that conform to the procedural sedation corresponding to ASA, the standard monitoring during anesthesia, and were published between 2003 and 2023 have been reviewed. From 17 till 20th of March a survey has been conducted. Throughout the survey, participants have anonymously filled a questionnaire via Google-Form. The link to the questionnaire was shared by the Department of Anesthesiology and Intensive Care of the Institute of Postgraduate Education of Bogomolets National University with support provided by Association of Anesthesiologists of Ukraine through social networks such as Facebook and Instagram on the official pages of the Department of Surgery, Anesthesiology, and Intensive Care of the Institute of Postgraduate Education of the Bogomolets National Medical University.
 Results. A total of 284 doctors took part in the survey. Among them 280 (98.5 %) have been working in Ukraine during the survey, 4 (1.5 %) have been excluded from the analysis. Pulse oximetry was regularly used by 278 (99.2 %), automatic arterial pressure measurement by 222 (79.4 %), manual measurement of arterial pressure by 35 (12.5 %), ECG-monitoring by 95 (34.2 %), capnography by 35 (12.5 %), thermometry by 10 (3.5 %), electroencephalography by 4 (1.6 %) of the doctors (Fig. 3). 36 (12.8 %) of the respondents have informed about the absence of technical means to conduct ECG-monitoring, 172 (62.5 %) have conducted it in a selective manner. The results are presented in form of descriptive statistics and diagrams.
 Conclusion. Procedural sedation is a safe method provided that modern safety standards are systematically followed. Full monitoring is a prerequisite for timely response to critical events and mitigation of their consequences. Reporting problems of any degree of criticality that occurred during sedation helps to optimize local practices and has a positive effect on the quality of medical care. Introduction of routine capnography, electrocardiography and thermometry are prioritized goals when it comes to increasing the quality of monitoring in Ukraine.