Office anesthesia

Question 1

Minimal Sedation (Anxiolysis)

Answer 1

is a drug-induced
state during which patients respond normally to verbal
commands. Although cognitive function and coordination
may be impaired, airway reflexes, ventilatory functions and
cardiovascular functions are unaffected

Question 2

Moderate Sedation/Analgesia

Answer 2

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. Cardiovascular function is usually
maintained

Question 3

Deep Sedation/Analgesia

Answer 3

is a drug-induced depression
of consciousness during which patients cannot be easily
aroused but respond purposefully** following repeated or
painful stimulation. The ability to independently maintain
ventilatory function may be impaired. Patients may require
assistance in maintaining a patent airway, and spontaneous
ventilation may be inadequate. Cardiovascular function is
usually maintained

Question 4

General Anesthesia

Answer 4

is a drug-induced loss of consciousness
during which patients are not arousable, even by painful
stimulation. The ability to maintain ventilatory function
independently is often impaired. Patients often require
assistance in maintaining a patent airway, and positive
pressure ventilation may be required because of depressed
spontaneous ventilation or drug-induced depression of
neuromuscular function. Cardiovascular function may be
impaired

Question 5

Anesthesia Team (as defined by AAOMS Parameters of
Care)

Answer 5

Moderate Sedation – The anesthesia team consists of the
surgeon, trained and currently competent in ACLS, and one
additional person trained and currently competent in Basic
Life Support (BLS) for Healthcare Providers.
Deep Sedation/General Anesthesia – The anesthesia team
consists of the surgeon, trained and currently competent
in ACLS, and two additional persons trained and currently
competent in BLS for Healthcare Providers. The individual
designated to monitor the patient’s level of sedation should
have no other responsibilities.

Question 6

Monitoring Equipment

Answer 6

Continuous, time-sensitive monitoring of all patients is
required. Equipment must include a blood pressure monitor
with an automated time determined capability and a
method for recording the data. An electrocardiographic
(ECG) monitor to visualize cardiac rhythms is required for
interpretation. Pulse oximetry must be used to follow the
oxygen saturation in the blood throughout the procedure
as a measure against the baseline value. Monitors with
print and/or storage capability are available. Capnography
should be considered in all anesthetics. During moderate
or deep sedation and general anesthesia, the adequacy of
ventilation shall be evaluated by continual observation of
qualitative clinical signs and monitoring for the presence of
exhaled carbon dioxide unless precluded or invalidated by
the nature of the patient, procedure or equipment. AAOMS
Office Anesthesia Evaluations require capnography for
moderate sedation, deep sedation and general anesthesia.
During general anesthesia where volatile inhalation agents
or succinylcholine is used, temperature must be continually
monitored. Consideration should be given to the use of a
precordial stethoscope during anesthesia administration to
listen to breath sounds and cardiac rhythm.

Question 7

Monitoring

Answer 7

The anesthesia record is time-oriented and includes
vital signs of the patient, types of drugs and amounts
administered, length of the procedure, names of the
personnel in the room and any complications of anesthesia
(see supplemental material at end of Chapter 1, Sample
Anesthetic Record). Furthermore, oxygen saturation
on room air is recorded before anesthetic agents are
administered and before discharge. For moderate sedation,
deep sedation and general anesthesia, the respiratory
rate, oxygen saturation, end tidal CO2, heart rate, blood
pressure and cardiac rhythm are monitored and recorded
every five minutes during the intraoperative period. When
endotracheal anesthesia is used, expired carbon dioxide
levels and temperatures are recorded every five minutes
until extubation