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González-Mendibil I, García-Pascual E, Villanueva A, García-Gutiérrez S. Bispectral index monitoring for sedation in scheduled adult colonoscopy: A randomized controlled trial. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2024:S2341-1929(24)00079-9. [PMID: 38663652 DOI: 10.1016/j.redare.2024.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 11/02/2023] [Accepted: 12/06/2023] [Indexed: 05/01/2024]
Abstract
BACKGROUND Patients should be closely monitored during procedures under sedation outside the operating room, but it is unclear which type of monitoring is best. We investigated the efficacy and safety of BIS monitoring vs conventional monitoring for sedation during colonoscopy. METHODS We performed a double-blind clinical trial in 180 patients undergoing elective colonoscopy. Patients were randomized to 1) the BIS group or 2) a control group, in which sedation was monitored with a BIS monitor or the Ramsay Sedation Score, respectively. The primary outcome was the rate of sedation-induced adverse events in both groups. Secondary outcomes were the characteristics of patients who developed adverse events, and time during colonoscopy when these events occurred, propofol and remifentanil dosage, and patient satisfaction. RESULTS Univariate analysis showed fewer cardiopulmonary complications in the BIS group (41.11% vs 57.78% in controls; p = 0.02). Multivariate analysis found a significantly higher risk of adverse events in older patients (95% CI, 1.013-1.091; p = 0.0087) and in men (95% CI, 1.129-7.668; p = 0.0272). These events were observed at the hepatic flexure. No significant differences between propofol or remifentanil dosage, use of rescue medication, and patient satisfaction were observed between groups. CONCLUSIONS Our data suggest that BIS monitoring during sedation in scheduled colonoscopies reduces adverse respiratory events. Although its routine use in sedation does not appear to be warranted, clinicians should take steps to identify patients with a higher risk of complications who might benefit from this type of monitoring.
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Affiliation(s)
- I González-Mendibil
- Department of Anesthesiology, Galdakao University Hospital, Galdakao, Bizkaia, Spain.
| | - E García-Pascual
- Department of Anesthesiology, Galdakao University Hospital, Galdakao, Bizkaia, Spain
| | - A Villanueva
- Research Unit, Galdakao University Hospital, Galdakao, Bizkaia, Spain; Kronikgune Institute for Health Services Research, Barakaldo, Bizkaia, Spain
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van der Meulen JF, Fisch C, Dreessen JRJ, Coppus SFPJ, Kok HS, Bongers MY. Procedural sedation and analgesia with propofol (PSA) for gynecologic surgery: A systematic review of the literature. Eur J Obstet Gynecol Reprod Biol 2023; 287:137-146. [PMID: 37327552 DOI: 10.1016/j.ejogrb.2023.05.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 05/03/2023] [Accepted: 05/25/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE To identify which gynecologic procedures are eligible to be performed under PSA with propofol and to describe safety and effectiveness of these procedures in this setting. METHODS A systematic review of the literature was conducted in Pubmed (MEDLINE), Embase and The Cochrane Library from inception until September 21st 2022. Cohort studies and randomized controlled trials were included when they reported on clinical outcomes of gynecologic procedures under procedural sedation and analgesia in which propofol was used as an anesthetic. Studies were excluded when sedation without propofol was used, when they only mentioned the use of procedural sedation and analgesia but did not describe any clinical outcome parameters or when < 10 patients were included. The primary outcome parameter was completeness of procedure. Secondary outcome parameters were type of gynecologic procedure, intraoperative complication rate, patient satisfaction, postoperative pain, duration of hospital admission, patient's discomfort and ease of procedure as judged by the surgeon. The Cochrane risk of bias tool and the ROBINS-I tool were used for bias assessment. A narrative synthesis of the findings from the included studies was provided. Numbers and percentages were presented, as well as means with standard deviations and medians with interquartile range where applicable. RESULTS Eight studies were included. A total of 914 patients underwent gynecologic surgical procedures with procedural sedation and analgesia with propofol. Gynecological procedures varied from hysteroscopic procedures, vaginal prolapse surgery and laparoscopic procedures. The percentage of complete procedures was 89.8%-100%. Complications occurred in 0-6.5% of patients. Other outcomes were measured in various ways, but overall patient satisfaction was high and postoperative pain was low. CONCLUSION The use of PSA with propofol is promising for a wide range of gynecologic procedures, including hysteroscopic procedures, vaginal prolapse surgery and laparoscopic procedures. The use of PSA with propofol seems to be effective and safe and leads to high degree of patient satisfaction. More research is needed in order to determine for which types of procedures PSA can be used.
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Affiliation(s)
- Julia F van der Meulen
- Department of Obstetrics and Gynecology, Máxima Medical Centre, Veldhoven, The Netherlands; Grow School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands.
| | - Charlotte Fisch
- Department of Obstetrics and Gynecology, Máxima Medical Centre, Veldhoven, The Netherlands; Department of Obstetrics and Gynecology, Radboud University Medical Centre, Nijmegen, The Netherlands.
| | - Janique R J Dreessen
- Department of Obstetrics and Gynecology, Zuyderland Medical Centre, Heerlen, The Netherlands.
| | - Sjors F P J Coppus
- Department of Obstetrics and Gynecology, Máxima Medical Centre, Veldhoven, The Netherlands.
| | - Helen S Kok
- Department of Obstetrics & Gynecology, Alrijne Ziekenhuis, Leiden, The Netherlands.
| | - Marlies Y Bongers
- Department of Obstetrics and Gynecology, Máxima Medical Centre, Veldhoven, The Netherlands; Grow School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
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Tariq A, Hill NS, Price LL, Ismail K. Incidence and Nature of Respiratory Events in Patients Undergoing Bronchoscopy Under Conscious Sedation. J Bronchology Interv Pulmonol 2022; 29:283-289. [PMID: 35275851 PMCID: PMC9470789 DOI: 10.1097/lbr.0000000000000837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 01/12/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND During diagnostic bronchoscopies, conscious sedation improves patient tolerance, but it can contribute to hypercapnia and hypoxia by various mechanisms including depression of ventilatory drive. This prospective study was undertaken to determine the frequency of respiratory events and associated oxygen desaturations during bronchoscopy with conscious sedation. PATIENTS AND METHODS The Nox-T3 monitoring system was placed before starting the bronchoscopy and remained in place for 30 minutes following the procedure. The primary endpoint was the occurrence of obstructive and central apneic events during bronchoscopy under conscious sedation. RESULTS Obstructive events (apnea and hypopnea) occurred in 100% of patients (n=31), and central apneas occurred in 58% of patients (n=18) during the procedure with a median of 9 and 2 events per patient, respectively. During recovery, a significant proportion of patients had detectable obstructive (86%) and central (36%) events. Higher body mass index was associated with oxygen desaturation to <90% and with the need for escalation of care. Furthermore, a conscious sedation regimen that included propofol was significantly associated with central apneic events. CONCLUSION Respiratory events are common during and immediately postprocedure after conscious sedation for bronchoscopy. Most events are obstructive, and the use of propofol predisposes to central apneas during the procedure. Both types of events are associated with a higher body mass index. Oxygen desaturation to <90% triggers escalation of care. A further prospective study will be required to determine the clinical significance of these apneic events and whether alleviating these events will improve the safety and outcomes of bronchoscopic procedures performed under conscious sedation.
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Affiliation(s)
- Asma Tariq
- Division of Pulmonary, Critical Care and Sleep Medicine, Tufts Medical Center, Boston MA
| | - Nicholas S. Hill
- Division of Pulmonary, Critical Care and Sleep Medicine, Tufts Medical Center, Boston MA
| | - Lori Lyn Price
- Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA
- Institute of Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA
| | - Khalid Ismail
- Division of Pulmonary, Critical Care and Sleep Medicine, Tufts Medical Center, Boston MA
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Frameworks for value-based care in the nonoperating room setting. Curr Opin Anaesthesiol 2022; 35:508-513. [PMID: 35861474 DOI: 10.1097/aco.0000000000001164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Nonoperating room anesthesia (NORA) presents a unique opportunity for the application of value-based care (VBC) principles to procedures performed in the office-based and nonoperating room inpatient settings. The purpose of this article is to review how value is defined in NORA and enabling principles by which anesthesiologists can maximize value in NORA. RECENT FINDINGS In order to drive value, NORA providers can target improvements in clinical outcomes where NORA lags behind operating room-based anesthesia (death, over-sedation, nerve injury), implement protocols focusing on intermediate outcomes/quality (postoperative nausea and vomiting, pain control, hypothermia, delirium), incorporate patient-reported outcomes (PROs) to assess the trajectory of a patient's perioperative care, and reduce costs (direct and indirect) through operational and supply-based efficiencies. Establishing a culture of patient and provider safety first, appropriate patient selection with targeted, perioperative optimization of comorbidities, and efficient deployment of staff, space, and resources are critical enablers for success. SUMMARY Value in NORA can be defined as clinical outcomes, quality, patient-reported outcomes, and efficiency divided by the direct and indirect costs for achieving those outcomes. We present a novel framework adapting current VBC practices in operating room anesthesia to the NORA environment.
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Affiliation(s)
- Angela Enright
- From the Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia.,Department of Anesthesiology, Royal Jubilee Hospital, Victoria, British Columbia, Canada
| | - Alan F Merry
- Department of Anaesthesiology, University of Auckland New Zealand, Auckland City Hospital, Auckland, New Zealand
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Comparative Safety Profiles of Sedatives Commonly Used in Clinical Practice: A 10-Year Nationwide Pharmacovigilance Study in Korea. Pharmaceuticals (Basel) 2021; 14:ph14080783. [PMID: 34451882 PMCID: PMC8399659 DOI: 10.3390/ph14080783] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 07/29/2021] [Accepted: 08/04/2021] [Indexed: 11/17/2022] Open
Abstract
This study aims to compare the prevalence and seriousness of adverse events (AEs) among sedatives used in critically ill patients or patients undergoing invasive procedures and to identify factors associated with serious AEs. Retrospective cross-sectional analysis of sedative-related AEs voluntarily reported to the Korea Adverse Event Reporting System from 2008 to 2017 was performed. All AEs were grouped using preferred terms and System Organ Classes per the World Health Organization-Adverse Reaction Terminology. Logistic regression was performed to identify factors associated with serious events. Among 95,188 AEs, including 3132 (3.3%) serious events, the most common etiologic sedative was fentanyl (58.8%), followed by pethidine (25.9%). Gastrointestinal disorders (54.2%) were the most frequent AEs. The most common serious AE was heart rate/rhythm disorders (33.1%). Serious AEs were significantly associated with male sex; pediatrics; etiologic sedative with etomidate at the highest risk, followed by dexmedetomidine, ketamine, and propofol; polypharmacy; combined sedative use; and concurrent use of corticosteroids, aspirin, neuromuscular blockers, and antihistamines (reporting odds ratio > 1, p < 0.001 for all). Sedative-induced AEs are most frequently reported with fentanyl, primarily manifesting as gastrointestinal disorders. Etomidate is associated with the highest risk of serious AEs, with the most common serious events being heart rate/rhythm disorders.
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Hypoxemia during procedural sedation in adult patients: a retrospective observational study. Can J Anaesth 2021; 68:1349-1357. [PMID: 33880728 PMCID: PMC8376691 DOI: 10.1007/s12630-021-01992-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 03/04/2021] [Accepted: 03/07/2021] [Indexed: 01/15/2023] Open
Abstract
PURPOSE Since 2010, new guidelines for procedural sedation and the Helsinki Declaration on Patient Safety have increased patient safety, comfort, and acceptance considerably. Nevertheless, the administration of sedatives and opioids during sedation procedures may put the patient at risk of hypoxemia. However, data on hypoxemia during procedural sedation are scarce. Here, we studied the incidence and severity of hypoxemia during procedural sedations in our hospital. METHODS A historical, single-centre cohort study was performed at the University Medical Centre Utrecht (UMCU), a tertiary centre in the Netherlands. Data from procedural sedation in our hospital between 1 January 2011 and 31 December 2018 (3,459 males and 2,534 females; total, 5,993) were extracted from our Anesthesia Information Management System. Hypoxemia was defined as peripheral oxygen saturation < 90% lasting at least two consecutive minutes. The severity of hypoxemia was calculated as area under the curve. The relationship between the severity of hypoxemia and body mass index (BMI), American Society of Anesthesiologists (ASA) Physical Status classification, and duration of the procedure was investigated. The primary outcome was the incidence of hypoxemia. RESULTS Twenty-nine percent of moderately to deeply sedated patients developed hypoxemia. A high incidence of hypoxemia was found in patients undergoing procedures in the heart catheterization room (54%) and in patients undergoing bronchoscopy procedures (56%). Hypoxemia primarily occurred in longer lasting procedures (> 120 min) and especially in the latter phases of the procedures. There was no relationship between severity of hypoxemia and BMI or ASA Physical Status. CONCLUSIONS This study showed that a considerable number of patients are at risk of hypoxemia during procedural sedation with a positive correlation shown with increasing duration of medical procedures. Additional prospective research is needed to investigate the clinical consequences of this cumulative hypoxemia.
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Abstract
PURPOSE OF REVIEW Advances in early diagnosis and treatment of diseases using minimally invasive procedures has led to an increase in the number of cases in locations outside the operating room. This surge created the need for anesthesia services to expand to these areas to provide well tolerated and favorable procedural conditions. The present review describes nonoperating room anesthesia patterns in different parts of the world. RECENT FINDINGS Nonoperating room anesthesia has grown exponentially over the last years. Patients scheduled in these areas are sicker and older compared to the operating room patients. Anesthesiologist-directed care has proven to be well tolerated, with less serious complications and improvement in patients and proceduralist satisfaction. SUMMARY There are marked variations in how anesthesia services are delivered in out of operating room locations in different parts of the world. Although there are some data available from the United States, expansion of minimally invasive procedures across continents will likely lead to the emergence of various models of delivering anesthetic care.
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Moderate and deep sedation training and pharmacology for nonanesthesiologists. Curr Opin Anaesthesiol 2019; 32:457-463. [DOI: 10.1097/aco.0000000000000758] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Truchot J, Mezaïb K, Ricard-Hibon A, Vicaut E, Claessens YE, Soulat L, Milon JY, Serrie A, Plaisance P. Assessment of procedural pain in French emergency departments: a multi-site, non-interventional, transverse study in patients with minor trauma injury. Hosp Pract (1995) 2019; 47:143-148. [PMID: 31343374 DOI: 10.1080/21548331.2019.1646074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: To determine the mean number of procedural painful episodes per patient, and to retrieve information regarding diagnosis, therapeutic procedures and analgesic management, in patients visiting Emergency Departments (EDs) for minor trauma. Methods: This observational, non-interventional, multicenter study in adult patients was performed in 35 French EDs. All patients entering the EDs for minor trauma on a specified day between noon and 10 pm were registered; consenting patients were included in the study. Pain intensity was assessed using a verbal Numerical Rating Scale from 0 (no pain) to 10 (worst possible pain). An episode was described as painful if the difference in pain intensity between pain just before the procedure and maximal pain during the procedure was ≥2. Two independent nurses recorded data on 1 day in each center. Results: Overall, 909 patients were registered, 422 were included in the study, and complete data for 409 patients (1899 procedures) were available for analysis. The mean number of painful episodes per patient was 1.0 ± 1.3. Fifty-one percent of patients reported at least one painful procedure episode. Twenty-one percent of procedures were considered painful. Clinical examination was the procedure most often reported as painful. No preventive or curative analgesic treatment was reported in 95.1% of procedures. Conclusions: There is a need for improvement in routine pain assessment and, therefore, procedural pain management for ED patients. Specific protocols should be developed for procedural pain management, and teams should be trained especially for procedures usually not considered painful.
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Affiliation(s)
- Jennifer Truchot
- Department of Emergency Medicine, Lariboisière University Hospital, AP-HP, Paris Diderot University , Paris , France
| | - Karima Mezaïb
- Department of Pain Medicine, Institut Gustave Roussy , Villejuif , France
| | | | - Eric Vicaut
- Clinical Research Unit, Fernand Widal University Hospital , Paris , France
| | | | - Louis Soulat
- Department of Emergency Medicine, Rennes University Hospital , Rennes , France
| | | | - Alain Serrie
- Department of Pain and Palliative Medicine, Lariboisière University Hospital , Paris , France
| | - Patrick Plaisance
- Department of Emergency Medicine, Lariboisière University Hospital, AP-HP, Paris Diderot University , Paris , France
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Abstract
OBJECTIVE. The purposes of this article are to describe implementation of an abbreviated brain MRI protocol for use in children with primary headache and to present an experience with the adaptation of the protocol in practice, work flow integration, and effects on sedation use. CONCLUSION. The abbreviated brain MRI protocol reduced the need for sedation for 74% of the study sample. Use of this protocol in this particular patient population continues, but further validation is required before its use is expanded to other pediatric populations.
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Capnography Monitoring for Patients Undergoing Moderate Sedation: An SGNA Fellowship Project. Gastroenterol Nurs 2019; 42:49-54. [PMID: 30688708 DOI: 10.1097/sga.0000000000000426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The purpose of this Society of Gastroenterology Nurses and Associates Fellowship project was to determine whether capnography is more accurate than oximetry in identifying symptoms of respiratory depression in patients undergoing moderate sedation. Capnography provides an early warning of respiratory depression and airway compromise, especially when the medications used for sedation include opiates and benzodiazepines. It is a standard of care according to the American Society of Anesthesiologists that should be adopted in order to provide the safest possible environment for the delivery of moderate sedation. During this project, the nursing staff were educated on the importance and usage of capnography. Evidence was gathered that helped show that by using capnography, nurses were able to identify signs of respiratory depression earlier and more frequently than with the use of oximetry and cardiac monitoring alone.
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Characteristics of Reported Adverse Events During Moderate Procedural Sedation: An Update. Jt Comm J Qual Patient Saf 2018; 44:651-662. [DOI: 10.1016/j.jcjq.2018.03.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 03/16/2018] [Indexed: 01/09/2023]
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Stone AB, Brovman EY, Greenberg P, Urman RD. A medicolegal analysis of malpractice claims involving anesthesiologists in the gastrointestinal endoscopy suite (2007–2016). J Clin Anesth 2018; 48:15-20. [DOI: 10.1016/j.jclinane.2018.04.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 04/13/2018] [Accepted: 04/15/2018] [Indexed: 11/26/2022]
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Braaten KP, Urman RD, Maurer R, Fortin J, Goldberg AB. A randomized comparison of intravenous sedation using a dosing algorithm compared to standard care during first-trimester surgical abortion. Contraception 2018; 97:490-496. [DOI: 10.1016/j.contraception.2018.01.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 01/23/2018] [Accepted: 01/24/2018] [Indexed: 01/21/2023]
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Arnal Velasco D, Romero García E, Martínez Palli G, Muñoz Corsini L, Rey Martínez M, Postigo Morales S. [Patient safety recommendations for out of operating room procedure sedation]. REVISTA DE CALIDAD ASISTENCIAL : ORGANO DE LA SOCIEDAD ESPANOLA DE CALIDAD ASISTENCIAL 2017; 32:155-165. [PMID: 27641104 DOI: 10.1016/j.cali.2016.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 07/18/2016] [Indexed: 06/06/2023]
Abstract
INTRODUCTION There is an increasing and more complex demand for sedation for procedures out of the operating room. For different reasons, nowadays the administration of sedation varies considerably. We believe that a patient safety approach rather an approach out of corporate or economic interests is desirable. METHOD We created a working group of experts within the Spanish Anaesthesia and Reanimation Incident Reporting System (SENSAR) to prepare a series of recommendations through a non-systematic review. These recommendations were validated by an expert panel of 31 anaesthesiologists through two rounds of an adaptation of the Delphi Method where more than 70% agreement was required. RESULTS The resulting recommendations include previous evaluation, material and staffing needs for sedation for procedures, post-sedation recommendations and activity and quality control advice. CONCLUSION We present patient centred recommendations for the safe use of sedation for out of the operating room procedures from the point of view of the professionals with the most experience in its administration. We believe that these can be used as a guide to reduce variability and increase patient safety in the organisation of healthcare.
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Affiliation(s)
- D Arnal Velasco
- Sistema Español de Notificación en Seguridad en Anestesia y Reanimación (SENSAR), Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España.
| | - E Romero García
- Sistema Español de Notificación en Seguridad en Anestesia y Reanimación (SENSAR), Hospital Universitario La Fe, Valencia, España
| | - G Martínez Palli
- Sistema Español de Notificación en Seguridad en Anestesia y Reanimación (SENSAR), Hospital Clínic y Centro de Investigaciones IDIBAPS, Barcelona, España
| | - L Muñoz Corsini
- Sistema Español de Notificación en Seguridad en Anestesia y Reanimación (SENSAR), Hospital Universitario de Guadalajara, Guadalajara, España
| | - M Rey Martínez
- Sistema Español de Notificación en Seguridad en Anestesia y Reanimación (SENSAR), Hospital Povisa, Vigo, Pontevedra, España
| | - S Postigo Morales
- Sistema Español de Notificación en Seguridad en Anestesia y Reanimación (SENSAR), Hospital de Galdakao, Usansolo, Bizkaia, España
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Arnal Velasco D, Romero García E, Martínez Palli G, Muñoz Corsini L, Rey Martínez M, Postigo Morales S. Patient safety recommendations for out of operating room procedure sedation. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2016; 63:577-587. [PMID: 27545841 DOI: 10.1016/j.redar.2016.07.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 07/15/2016] [Accepted: 07/18/2016] [Indexed: 11/29/2022]
Abstract
INTRODUCTION There is an increasing and more complex demand for sedation for procedures out of the operating room. For different reasons, nowadays the administration of sedation varies considerably. We believe that a patient safety approach rather an approach out of corporate or economic interests is desirable. METHOD We created a working group of experts within the Spanish Anaesthesia and Reanimation Incident Reporting System (SENSAR) to prepare a series of recommendations through a non-systematic review. These recommendations were validated by an expert panel of 31 anaesthesiologists through two rounds of an adaptation of the Delphi Method where more than 70% agreement was required. RESULTS The resulting recommendations include previous evaluation, material and staffing needs for sedation for procedures, post-sedation recommendations and activity and quality control advice. CONCLUSION We present patient centred recommendations for the safe use of sedation for out of the operating room procedures from the point of view of the professionals with the most experience in its administration. We believe that these can be used as a guide to reduce variability and increase patient safety in the organisation of healthcare.
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Affiliation(s)
- D Arnal Velasco
- Sistema Español de Notificación en Seguridad en Anestesia y Reanimación (SENSAR), Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España.
| | - E Romero García
- Sistema Español de Notificación en Seguridad en Anestesia y Reanimación (SENSAR), Hospital Universitario La Fe, Valencia, España
| | - G Martínez Palli
- Sistema Español de Notificación en Seguridad en Anestesia y Reanimación (SENSAR), Hospital Clínic y Centro de Investigaciones IDIBAPS, Barcelona, España
| | - L Muñoz Corsini
- Sistema Español de Notificación en Seguridad en Anestesia y Reanimación (SENSAR), Hospital Universitario de Guadalajara, Guadalajara, España
| | - M Rey Martínez
- Sistema Español de Notificación en Seguridad en Anestesia y Reanimación (SENSAR), Hospital Povisa, Vigo, Pontevedra, España
| | - S Postigo Morales
- Sistema Español de Notificación en Seguridad en Anestesia y Reanimación (SENSAR), Hospital de Galdakao, Usansolo, Bizkaia, España
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Rosero EB, Joshi GP. Ambulatory Anesthesia in Remote Locations. CURRENT ANESTHESIOLOGY REPORTS 2016. [DOI: 10.1007/s40140-016-0181-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Applegate RL, Lenart J, Malkin M, Meineke MN, Qoshlli S, Neumann M, Jacobson JP, Kruger A, Ching J, Hassanian M, Um M. Advanced Monitoring Is Associated with Fewer Alarm Events During Planned Moderate Procedure-Related Sedation: A 2-Part Pilot Trial. Anesth Analg 2016; 122:1070-8. [PMID: 26836134 PMCID: PMC4791313 DOI: 10.1213/ane.0000000000001160] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Supplemental Digital Content is available in the text. Published ahead of print February 1, 2016 Diagnostic and interventional procedures are often facilitated by moderate procedure-related sedation. Many studies support the overall safety of this sedation; however, adverse cardiovascular and respiratory events are reported in up to 70% of these procedures, more frequently in very young, very old, or sicker patients. Monitoring with pulse oximetry may underreport hypoventilation during sedation, particularly if supplemental oxygen is provided. Capnometry may result in false alarms during sedation when patients mouth breathe or displace sampling devices. Advanced monitor use during sedation may allow event detection before complications develop. This 2-part pilot study used advanced monitors during planned moderate sedation to (1) determine incidences of desaturation, low respiratory rate, and deeper than intended sedation alarm events; and (2) determine whether advanced monitor use is associated with fewer alarm events.
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Affiliation(s)
- Richard L Applegate
- From the *Department of Anesthesiology, Loma Linda University School of Medicine, Loma Linda, California; †Department of Anesthesiology, Loma Linda University School of Medicine, Loma Linda, California; and ‡Department of Radiology, Loma Linda University School of Medicine, Loma Linda, California
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Chang B, Urman RD. Non-operating Room Anesthesia: The Principles of Patient Assessment and Preparation. Anesthesiol Clin 2016; 34:223-240. [PMID: 26927750 DOI: 10.1016/j.anclin.2015.10.017] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
A significant number of anesthetics are performed outside of the operating room (OR). Despite the increased requirement for anesthesia services, the framework to perform the necessary preprocedural anesthesia assessments to optimize patients has not been uniformly developed. Performing anesthesia in non-OR locations poses significant and distinct challenges compared with the procedures in the OR. Anesthesiologists are faced with patients with increasingly complicated comorbidities undergoing novel, complex interventional procedures. With unique training in preoperative triaging, and an expertise in intraoperative and postoperative management of complex patients, anesthesiologists can contribute to greater efficiency and patient safety in the non-OR setting.
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Affiliation(s)
- Beverly Chang
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford Hospital and Clinics, 300 Pasteur Drive H3580, Stanford, CA 94305, USA
| | - Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
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