Extra Topic 3.4 -- Practice Management – Endoscopy Suite

Question 1

What is your definition of conscious sedation?

(You are asked to write a “conscious sedation” policy for the new endoscopy suite in your hospital.)

Answer 1

According to the ASA statement on the definition of general anesthesia and the levels of sedation/analgesia (amended Oct 21, 2009),

moderate sedation/analgesia (“Conscious Sedation”) is a drug-induced depression of consciousness during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation.

No interventions are required to maintain a patent airway, and spontaneous ventilation is adequate.

Question 2

What training and supervision would you recommend for non-anesthesia sedation providers?

(You are asked to write a “conscious sedation” policy for the new endoscopy suite in your hospital.)

Answer 2

Only physicians, dentists or podiatrists who are qualified by education, training, and licensure to administer moderate sedation should supervise the administration of moderate sedation.

Non-anesthesiologist sedation practitioners may directly supervise patient monitoring and the administration of sedative and analgesic medications by a supervised sedation professional.

–

The supervised sedation professional who is granted privileges to administer sedative and analgesic drugs under supervision of a non-anesthesiologist sedation practitioner or anesthesiologist and to monitor patients during moderate sedation, can be a registered nurse who has graduated from a qualified school of nursing or a physician assistant who has graduated from an accredited physician assistant program.

They may only administer sedative and analgesic medications on the order of an anesthesiologist or non-anesthesiologist sedation practitioner.

They should have satisfactorily completed a formal training program in –

1. the safe administration of sedative and analgesic drugs used to establish a level of moderate sedation,
2. use of reversal agents for opioids and benzodiazepines,
3. monitoring of patients’ physiologic parameters during sedation, and
4. recognition of abnormalities in monitored variables that require intervention by the non-anesthesiologist sedation practitioner or anesthesiologist.

Question 3

What equipment would you require be immediately available?

(You are asked to write a “conscious sedation” policy for the new endoscopy suite in your hospital.)

Answer 3

The ASA has set standards for non-operating room anesthetizing locations.

(Statement on non-operating room anesthetizing locations Oct 22, 2008)

At minimum I would require –

• 2 sources of oxygen,
• ASA standard monitors,
• airway equipment,
• emergency medications,
• crash cart,
• a battery powered flashlight, and
• personnel trained in cardiopulmonary resuscitation.

Question 4

How would you plan to recover patients following endoscopy?

(You are asked to write a “conscious sedation” policy for the new endoscopy suite in your hospital.)

Answer 4

The ASA standards for post anesthetic care apply to all locations and all patients who have received general anesthesia, regional anesthesia, or monitored anesthesia care.

In general, the standards include transfer of the patient to a designated PACU or equivalent area by a member of the anesthesia team, a verbal report of the patient given to the PACU nurse, continual evaluation, and monitoring in the immediate post-operative period.

General medical supervision, coordination of patient care, and discharge from the PACU should be the responsibility of an anesthesiologist.