Guideline for use of anaesthesia and conscious sedation

Author: Dr. Gregory Sund, Head of Department of Anaesthesia

Targeted users: Qualified anaesthesia providers including KRNA and consultant anaesthesiologists

Purpose: To provide recommendations for administration of conscious sedation and monitoring guidelines during sedation and anaesthesia.

Recommendations for Patient Monitoring

Periodically (e.g., at 5-min intervals) monitor a patient’s response to verbal commands during moderate sedation, except in patients who are unable to respond appropriately (e.g., patients where age or development may impair bidirectional communication) or during procedures where movement could be detrimental
During procedures where a verbal response is not possible (e.g., oral surgery, restorative dentistry, upper endoscopy), check the patient’s ability to give a “thumbs up” or other indication of consciousness in response to verbal or tactile (light tap) stimulation; this suggests that the patient will be able to control his airway and take deep breaths if necessary

Continually monitor ventilatory function by observation of qualitative clinical signs
Continually monitor ventilatory function with capnography unless precluded or invalidated by the nature of the patient, procedure, or equipment
For uncooperative patients, institute capnography after moderate sedation has been achieved
Continuously monitor all patients by pulse oximetry with appropriate alarms

Determine blood pressure before sedation/analgesia is initiated unless precluded by lack of patient cooperation
Once moderate sedation/analgesia is established, continually monitor blood pressure (e.g., at 5-min intervals) and heart rate during the procedure unless such monitoring interferes with the procedure (e.g., magnetic resonance imaging where stimulation from the blood pressure cuff could arouse an appropriately sedated patient)
Use electrocardiographic monitoring during moderate sedation in patients with clinically significant cardiovascular disease or those who are undergoing procedures where dysrhythmias are anticipated

Assure that a designated individual other than the practitioner performing the procedure is present to monitor the patient throughout the procedure

The individual responsible for monitoring the patient should be trained in the recognition of apnea and airway obstruction and be authorized to seek additional help
The designated individual should not be a member of the procedural team but may assist with minor, interruptible tasks once the patient’s level of sedation/analgesia and vital signs have stabilized, provided that adequate monitoring for the patient’s level of sedation is maintained

Use supplemental oxygen during moderate procedural sedation/analgesia unless specifically contraindicated for a particular patient or procedure

After sedation/analgesia, observe and monitor patients in an appropriately staffed and equipped area until they are near their baseline level of consciousness and are no longer at increased risk for cardiorespiratory depression
Monitor oxygenation continuously until patients are no longer at risk for hypoxemia
Monitor ventilation and circulation at regular intervals (e.g., every 5 to 15 min) until patients are suitable for discharge
Design discharge criteria to minimize the risk of central nervous system or cardiorespiratory depression after discharge from observation by trained personnel