Procedural sedation: A review of sedative agents, monitoring, and management of complications

Abstract

Given the continued increase in the complexity of invasive and noninvasive procedures, healthcare practitioners are faced with a larger number of patients requiring procedural sedation. Effective sedation and analgesia during procedures not only provides relief of suffering, but also frequently facilitates the successful and timely completion of the procedure. However, any of the agents used for sedation and/or analgesia may result in adverse effects. These adverse effects most often affect upper airway patency, ventilatory function or the cardiovascular system. This manuscript reviews the pharmacology of the most commonly used agents for sedation and outlines their primary effects on respiratory and cardiovascular function. Suggested guidelines for the avoidance of adverse effects through appropriate pre-sedation evaluation, early identification of changes in respiratory and cardiovascular function, and their treatment are outlined.

Effects of Natural Sounds on Pain: A Randomized Controlled Trial with Patients Receiving Mechanical Ventilation Support

“…Although sedation and analgesia have improved significantly in recent years, nurses are often concerned that adverse drug reactions may compromise the patient (Tobias & Leder, 2011). Analgesics are not free of adverse effects, such as sedation, emesis, anxiety, agitation or delirium (Arbour 2000, Jordan 2008), prolongation of mechanical ventilation or hospital stay and increased healthcare costs (Bobek et al 2001, Egerod 2002.…”

Midazolam inhibits chondrogenesis via peripheral benzodiazepine receptor in human mesenchymal stem cells

“…Benzodiazepines are widely used sedative drugs for applying regional anaesthesia 1. To obtain more specific functions to treat patients, numerous types of benzodiazepine derivatives have been synthesized.…”

Changing Trends in Dental Procedural Sedation

“…Midazolam can be administered by various route including oral, nasal, buccal, transmucosal, intramuscular and intravenous ones. Midazolam can potentiate the respiratory depression action of opioid or other respiratory depressant [2,16] .…”

“…The greatest threat to the safety of intravenous sedation is airway compromise, loss of airway reflexes and risk of aspiration particularly in dental procedure and hemodynamic instability. To reduced the risk of cardio-respiratory compromise it is very essential to identify highrisk patient, appropriate selection of medications, adherence to dosing recommendation, appropriate intraprocedural monitoring and prompt intervention when adverse effects are recognized [2] . Most of the time Intravenous (IV) sedation is combined with nitrous oxide.…”

“…Longer acting opioid such as morphine, pethidine are certainly not the agent of choice for procedural sedation because of slower onset and longer duration of action. Shorter acting opioid like fentanyl, alfentanyl sufentanil are often used as analgesic component along with other sedative agent for painful procedural sedation [63] . The role of opioid in procedural sedation in dentistry is questionable as the analgesic effect is trivial in most cases because most patients receive local anesthesia.…”