The term moderate sedation/analgesia is used throughout this document in the recommendations and activities. It is not the intent of this guideline to address situations that require the services of an anesthesia professional or to substitute the services of a perioperative RN in those situations that require the services of an anesthesia professional. The following topics are outside the scope of this document: local anesthesia, local monitored anesthesia care, general anesthesia, regional anesthesia (eg, spinal, epidural), total intravenous anesthesia, minimal sedation, deep sedation, endotracheal intubation, laryngoscopy, awake intubation, fospropofol, etomidate, chloral hydrate, nitrous oxide, RN-administered continuous infusion of sedatives, propofol administration in the emergency room and intensive care unit, sedation for intubated and mechanically ventilated patients, palliative care, premedication for general anesthesia, pain management following discharge from the postanesthesia care unit (PACU), surgical or procedural techniques, target-controlled infusion, and computer-assisted personalized sedation. The patient may slip into a deeper level of sedation than intended therefore, practitioners who administer moderate sedation/analgesia need to be able to rescue a patient who enters deep sedation/analgesia. Patients’ responses to the medications for moderate sedation/analgesia are unpredictable. 1,2ĭepth of sedation occurs across a continuum from minimal sedation to moderate sedation/analgesia, to deep sedation/analgesia, and finally general anesthesia. There are minimal variations in the patient’s vital signs. The patient maintains adequate, spontaneous ventilation. The patient maintains protective reflexes and is able to communicate verbally. The patient is able to respond purposefully to verbal commands or light tactile stimulation. The four distinct characteristics of moderate sedation/analgesia are the following: Moderate sedation produces a condition in which the patient exhibits a mildly depressed level of consciousness and an altered perception of pain. The patient can experience some degree of amnesia. The primary goal of moderate sedation/analgesia is to reduce the patient’s anxiety and discomfort so that they can tolerate diagnostic, therapeutic, and invasive procedures. The aim of moderate sedation/analgesia is to achieve a drug-induced, mild depression of consciousness with the use of sedatives or a combination of sedatives and analgesic medications, most often administered intravenously, and titrated to achieve a desired effect. Guidance is provided for determining the scope of nursing practice related to administration of moderate sedation/analgesia, patient selection criteria, pre-sedation patient assessment (eg, airway, difficult mask ventilation, obstructive sleep apnea), intraoperative continual patient monitoring, staffing, medication administration, and postoperative discharge criteria. This document provides guidance for care of the patient receiving moderate sedation/analgesia administered by a registered nurse (RN) in the perioperative practice setting.
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