moderate sedation

[bentrider]

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If a patient receives 1 mg of versed and 25 micrograms of fentanyl for cardiac cath would members call this moderate sedation?

 

[Idiopathic]

depends on how sedated the patient was. i think that is a subjective assessment.

 

[bentrider]

We need to decide if the sedation provided by these agents at these doses should be considered moderate sedation since a yes decision requires that the moderate sedation policy must be followed.

 

[bostonblaz]

Po meds are sedation. Iv meds are moderate sedation. Deep sedation is GANA or what most people call MAC these days

 

[IlDestriero]

It would probably be prudent to have safeguards and a policy for all sedation. We do. Its too easy for a light sedation to turn into deep sedation, and patients are unpredictable. In kids, conscious sedation is usually actually deep sedation, or GA with an unsecured airway. In an OSA patient that combo could be enough to be very sedated. I've been there not long ago with a 60 kg teen. 25mcg fentanyl for pain intraop. No wakey wakey 40 min later.

 

[goosegas]

ASA definitions for levels of sedation

 

[pgg]

The actual terms (conscious, moderate, deep sedation) have actual definitions that don't change based on which drug or how much you use.

The cocktail specified might be conscious sedation in a 22 year old and deep sedation in a 92 year old. You may be setting your policy up for failure by misusing the terms and setting hard dosage caps.

 

[RabbMD]

Just did a cardioversion x 2 shocks, 5 minutes apart with a total of 1mg versed. The 84yo demented septic pt was mod to deeply sedated as a case in point.

 

[Idiopathic]

The actual terms (conscious, moderate, deep sedation) have actual definitions that don't change based on which drug or how much you use.

The cocktail specified might be conscious sedation in a 22 year old and deep sedation in a 92 year old. You may be setting your policy up for failure by misusing the terms and setting hard dosage caps.

my point exactly. sedation is an assessment of condition, not a prescription.

 

[Oggg]

I think moderate sedation at our place requires the patient to be able to talk back to you -- if they're barely arousable it's deep sedation and that requires ER or Anesthesiologist.

 

[pgg]

There is no need to reinvent the wheel here. The heavy lifting has been done:

Continuum of Depth of Sedation: Definition of General Anesthesia and Levels of Sedation/Analgesia (2009)

Granting Privileges for Administration of Moderate Sedation to Practitioners Who Are Not Anesthesia Professionals, Statement on (2011)

Granting Privileges for Deep Sedation to Non-Anesthesiologist Sedation Practitioners, Advisory on (2010)


And related to the above, our current monitoring standards require use of capnography for moderate or deep sedation. Some people argue that this standard doesn't apply to non-anesthesiologists, but I think that as long as we as anesthesiologists are involved in training, supervising, or credentialing other sedation-qualified people, or are involved in creating an institution's policies concerning sedation, we really ought to be

1) Using the actual definitions for conscious vs moderate vs deep sedation. Words have meaning!

2) Applying our standards as much as possible (eg, forcing all sedation-qualified nurses to use capnography).