Sedation in Medical Retrieval – Challenges and Future Practice

Abstract

Anaesthetic Awareness is the recall of events that occur during sedation and is a serious complication thought to occur in 0.1 to 0.2 % of the general surgical population. Sedation is an important tool used in medical retrieval, however its use in the aerospace environment is unique in its challenges for clinicians. Many of the patients carry risk factors for anaesthetic awareness and the mode of anaesthesia appropriate for the aerospace environment, total intravenous anaesthesia, also carries a higher risk compared to other methods. In addition the aerospace environment has other challenges not specific to sedation including noise distractions and the physiological effects of high altitude on patients which can impact on the ability to provide adequate sedation. Given all this, patients receiving sedation during medical retrieval would seem to be at a higher risk of anaesthetic awareness than many of their counterparts on the ground. For many high risk patients in hospitals technology such as brain monitoring has been shown to be effective in reducing awareness. Therefore as patients in the air are as likely, if not more likely to be at risk of awareness the use of this aid in medical retrieval is raised for consideration. However this technology will only ever be an adjunct to clinical expertise and an overall understanding of the flight environment and its challenges will allow for best patient care possible and the reduction of awareness during sedation.