What is procedural sedation?

Updated: Sep 21, 2020
  • Author: Alma N Juels, MD; Chief Editor: Erik D Schraga, MD  more...
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Answer

Answer

The American College of Emergency Physicians (ACEP) defines procedural sedation as "a technique of administering sedatives or dissociative agents with or without analgesics to induce a state that allows the patient to tolerate unpleasant procedures while maintaining cardiorespiratory function. Procedural sedation and analgesia (PSA) is intended to result in a depressed level of consciousness that allows the patient to maintain oxygenation and airway control independently." [1]

The number of noninvasive and minimally invasive procedures performed outside of the operating room has grown exponentially over the last several decades. Sedation, analgesia, or both may be needed for many of these interventional or diagnostic procedures. Sedation and analgesia introduces an independent risk factor for morbidity and mortality in addition to the procedure itself. Medications that elicit pharmacologic effects, such as anxiolysis, amnesia, or analgesia, provide patient comfort during various procedures. 

Guidelines for procedural sedation have been available since 1985 for dentists and pediatricians through their societies. [2, 3] They have since expanded to other specialties including emergency medicine. [4] In October 2014, the American Society of Anesthesiologists (ASA) Committee on Standards and Practice Parameters recommended new guidelines for moderate sedation to guide various practitioners and encourage education and training. The guidelines cover core sedation principles and should be customized to address specific specialty needs. [5] An ongoing quality improvement review and implementation of these guidelines are necessary. Hospitals should establish these guidelines for their providers in accordance to their available resources. [6]

The information described in this article does NOT apply to the following types of patients:

  • Patients receiving inhaled anesthetics

  • Patients receiving analgesia for pain control without sedation

  • Patients receiving sedation to manage behavioral emergencies

  • Patients who are intubated


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