13.1 Sedation

Question 1

a) Complete the table in your answer booklet with the four levels of sedation in the American Society
of Anesthesiologists (ASA) continuum of sedation (top row) and th

Answer 1

Minimal sedation: anxiolysis

Moderate sedation: conscious sedation

Deep sedation

General anaesthesia

Question 2

Clinical features seen at each level (columns below). (8 marks)

Answer 2

Table page 153 of pdf

Responsiveness Normal response to
verbal stimulation.
Purposeful response
to verbal or light
tactile stimulation.
Purposeful response
to repeated or
painful stimulation.
No response.
Airway Unaffected. No intervention
required.
Intervention may be
required.
Intervention
usually required.
Spontaneous
ventilation
Unaffected. Adequate. May be inadequate. Frequently
inadequate.
Cardiovascular
function
Unaffected. Usually maintained. Usually maintained. May be impaired.

Question 3

b) Outline drugs that may be used and their methods of administration, when providing sedation for this
patient. (4 marks)

Answer 3

> > Nitrous oxide/oxygen 50:50 (entonox) via inhalation.

> > Temazepam via oral route.

> > Midazolam via intravenous, oral or intranasal route.

> > Small, single dose of fentanyl via intravenous route, wait until peak effect. May be followed by cautious intravenous midazolam titration.

Question 4

c) What are the best practice principles for providing safe sedation to this patient? (8 marks)

Answer 4

> > Environment:
adequate monitoring, equipment, resuscitation facilities and drugs (checked and working),
reversal agents, suitable area for patient recovery.

> > Staffing:
staff trained in adult life support (ALS), sufficient staff to monitor patient
after procedure whilst recovering from sedation.

> > Patient consent:
written information detailing what conscious sedation is,
options available, and associated risks.

> > Patient selection/pre-procedure assessment:
assessment for comorbidities, patient in agreement with plan.

Question 5

c) What are the best practice principles for providing safe sedation to this patient? (8 marks)

Answer 5

Peri-procedure management:

monitoring (noninvasive blood pressure, capnography, oxygen saturations plus ECG if indicated by patient comorbidities),
oxygen, minimum sedation necessary,
ideally just entonox, careful titration of dose,
allowing each dose to reach peak effect.

Opioid administration only if pain likely to be a significant feature
of the procedure that cannot be managed with local anaesthetic alone
(discuss with dentist) and then only small dose of short-acting drug, i.e. fentanyl.

> > Postprocedure care:
suitable area for recovery with member of staff trained to care for and
monitor such a patient (may be appropriate for anaesthetist to remain with patient),
discharge to care of responsible adult who will escort patient home
and remain with them for 24 hours.

Discharge only to take place when patient orientated and observations stable.
Written information to be provided regarding complications, advice to not drive/operate machinery/make important decisions for 24 hours, contact numbers for advice and what to do in an emergency.

> > Clinical governance,
audit, education and training: staff competencies in all areas of practice to be maintained (e.g. resuscitation, recovery etc.).

Critical incident reporting and analysis.