Guidelines for Monitoring Assistants Who Administer Moderate Procedural Sedation

Divino Plastic Surgery Blog by Dr. Carlos Chacon

November 10, 2022

Guidelines for Monitoring Assistants Who Administer Moderate Procedural Sedation

Moderate procedural sedation is an option for patients undergoing minor surgery. Patients undergoing this anesthetic procedure should be in good general health and have an adequate ventilatory reserve. Patients with significant medical conditions should be evaluated by an anesthesiologist or an attending physician specializing in the primary disease process before undergoing this sedation technique.

Medical necessity review

Determining if a patient requires moderate procedural sedation begins with a comprehensive review of the patient’s medical and surgical history. A focused physical examination of the airway and other vital signs is also part of the evaluation. The medical team also reviews current medications and allergies. The assessment should determine if a patient is a good candidate for moderate procedural sedation in an accredited surgical centre.

After the sedation procedure, the responsible physician will reexamine the patient to ensure that they are recovering and that their physiological status has returned to their baseline pre-procedural level. A qualified LIP may apply specific discharge criteria, which must be met for the patient to be safely discharged. The objective of moderate procedural sedation should be to prevent loss of consciousness.

Assessing the patient’s airway, heart, and respiratory rate is critical. The monitoring of blood pressure and oxygen saturation is also essential. In addition, the nurse must monitor the patient’s level of consciousness, the type of fluids used and the amount of medication administered. Additionally, a patient’s protective reflexes must be intact, and the pain must be controlled.

Pre-procedure evaluation

A pre-procedure evaluation aims to determine whether moderate procedural sedation is appropriate for the patient prior to surgery. This process involves thoroughly assessing the patient’s health and any preexisting conditions. This evaluation may also include a focused physical examination of the airway. In addition, the pre-procedure assessment should consist of a review of all consultations, laboratory tests, and any medication and allergy history. It is important to note that the pre-procedure evaluation is the first entry on the anesthesia record and that a qualified individual should evaluate all patients under moderate sedation.

The physician’s experience and training should be the primary consideration when determining whether moderate sedation is appropriate for a patient. In addition, the patient’s vital signs must be monitored closely before undergoing any procedure, including orthopedic surgery. Patients may require sedation if they experience considerable discomfort and cannot remain still during a process. Whether a patient needs moderate sedation will depend on the level of pain he is experiencing and the need for muscle relaxation.

Induction agents

Induction agents are used in medical procedures to induce sedation in patients. The amount and timing of induction agents should be carefully considered for each patient. Some sedatives can cause adverse effects in pregnant women. In addition, moderate sedation is associated with increased heartburn and reflux esophagitis in pregnant women. The fetus can tolerate short periods of mild maternal hypoxemia, but longer exposures can result in fetal respiratory acidosis, myocardial depression, and uterine artery vasoconstriction.

Induction agents for moderate procedural sedations include opioids, midazolam, and anxiolytics. The titration of these drugs is crucial and should be done by experienced staff. Increasingly, induction agents are used for procedures outside the operating room. These drugs can quickly progress to deep sedation and general anesthesia.

Moderate sedation is a level of depression of consciousness that does not affect the ability to maintain spontaneous ventilation, airway patency, or cardiovascular function. This type of sedation allows the physician to perform procedures without the patient experiencing excessive pain or anxiety. It also provides anxiolysis and controls unwanted movement. As a result, moderate sedation is considered a good target for non-anesthesiologist supervision.

Monitoring assistant

The guidelines for monitoring assistants who administer moderate procedural sedation include several elements. The first is to ensure that the patient is positioned in a comfortable position. The patient is grounded using an electrocautery grounding pad and fitted with defibrillation patches. The patient’s blood pressure and oxygen saturation should be monitored regularly. The monitoring assistant also needs to record relevant intra-procedure events and medications.

The guidelines also call for two trained staff members. The staff member monitoring the patient must recognize signs of apnea and airway obstruction and must be able to manage airway emergencies. Depending on the type of procedure, the state may have additional requirements for monitoring assistants. The entire team must be briefed on the patient’s condition and the process.

In addition to the monitoring assistant’s role during a procedure, the monitoring assistant should assess the patient’s medical suitability. The pre-sedation evaluation should include a focused physical examination and history to identify any acute or chronic illnesses that may require particular interventions. Patients with specific co-morbidities or medical conditions may be at high risk for adverse outcomes such as cardiovascular or respiratory problems.