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Chapter 12 - Management of Complications of Moderate and Deep Sedation

Published online by Cambridge University Press:  12 December 2024

Richard D. Urman
Affiliation:
Ohio State University
Alan David Kaye
Affiliation:
Louisiana State University School of Medicine
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Summary

Intravenous pharmacologic sedation is often chosen for surgical and nonsurgical procedures and is administered by an anesthesiologist, nurse anesthetist, or other trained professional. Sedation is described as a continuum, encompassing minimal, moderate, and deep sedation that can be categorized according to the patient’s level of consciousness (Figure 12.1). This categorization is subjective and the different levels of sedation can be achieved through changes in medication choice and dosage. There exist overlapping zones between levels of sedation. In clinical practice, deep sedation and general anesthesia share many of the same features in terms of patient awareness, lack of responsiveness, and risk of airway compromise.

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Publisher: Cambridge University Press
Print publication year: 2024

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References

Boynes, SG, Lewis, CL, Moore, PA, Zovko, J, Close, J. Complications associated with anesthesia administered for dental treatment. Gen Dent. 2010;58(1):e20–5.Google ScholarPubMed
Nisbet, AT, Mooney-Cotter, F. Comparison of selected sedation scales for reporting opioid-induced sedation assessment. Pain Manag Nurs. 2009;10(3):154–64.CrossRefGoogle ScholarPubMed
Sessler, CN, Gosnell, MS, Grap, MJ, et al. The Richmond Agitation–Sedation Scale: validity and reliability in adult intensive care unit patients. Am J Respir Crit Care Med. 2002;166(10):1338–44.CrossRefGoogle ScholarPubMed
Waldmann, C. Using and understanding sedation scoring systems. JICS. 2010;11(1):1516.Google Scholar
Shi, S, Klotz, U. Age-related changes in pharmacokinetics. Curr Drug Metab. 2011;12(7):601–10.CrossRefGoogle ScholarPubMed
Garcia, CJ, Lopez, OA, Islam, S, et al. Endoscopic retrograde cholangiopancreatography in the elderly. Am J Med Sci. 2016;351(1):8490.CrossRefGoogle ScholarPubMed
Weaver, CS, Terrell, KM, Bassett, R, et al. ED procedural sedation of elderly patients: is it safe? Am J Emerg Med. 2011;29(5):541–4.CrossRefGoogle ScholarPubMed
Martin, ML, Lennox, PH. Sedation and analgesia in the interventional radiology department. J Vasc Interv Radiol. 2003;14(9):1119–28.CrossRefGoogle ScholarPubMed
Jirapinyo, P, Thompson, CC. Sedation challenges: obesity and sleep apnea. Gastrointest Endosc Clin N Am. 2016;26(3):527–37.CrossRefGoogle ScholarPubMed
Bautista, A, Hrushka, L, Lenhardt, R. Procedural sedation in the morbidly obese: implications, complications, and management. Int Anesthesiol Clin. 2020;58(3):41–6.CrossRefGoogle ScholarPubMed
Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: application to healthy patients undergoing elective procedures: an updated report by the American Society of Anesthesiologists Task Force on preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration. Anesthesiology. 2017;126:376–93.CrossRefGoogle Scholar
Friedrich, S, Meybohm, P, Kranke, P. Nulla per os (NPO) guidelines: time to revisit? Curr Opin Anaesthesiol. 2020;33(6):740–5.CrossRefGoogle ScholarPubMed
Reitman, E, Flood, P. Anaesthetic considerations for non-obstetric surgery during pregnancy. Br J Anaesth. 2011;107(Suppl 1):i72–8.CrossRefGoogle ScholarPubMed
Vasco Ramirez, M, Valencia, G CM. Anesthesia for nonobstetric surgery in pregnancy. Clin Obstet Gynecol. 2020;63(2):351–63.CrossRefGoogle ScholarPubMed
Heesen, M, Klimek, M. Nonobstetric anesthesia during pregnancy. Curr Opin Anaesthesiol. 2016 June;29(3):297303.CrossRefGoogle ScholarPubMed
Calcaterra, SL, Butler, M, Olson, K, Blum, J. The impact of a PDMP–EHR data integration combined with clinical decision support on opioid and benzodiazepine prescribing across clinicians in a metropolitan area. J Addict Med. 2021;11:10.Google Scholar
Waljee, JF, Zhong, L, Hou, H, et al. The use of opioid analgesics following common upper extremity surgical procedures: a national, population-based study. Plast Reconstr Surg. 2016;137(2):355e–64e.CrossRefGoogle ScholarPubMed
Chino, K, Ganzberg, S, Mendoza, K. Office-based sedation/general anesthesia for COPD patients, Part II. Anesth Prog. 2019;66(1):4451.CrossRefGoogle ScholarPubMed
Jirapinyo, P, Thomson, CC. Sedation challenges: obesity and sleep apnea. Gastrointest Endosc Clin N Am. 2016; 26(3):527–37.CrossRefGoogle ScholarPubMed
Derry, S, Straube, S, Moore, RA, Hancock, H, Collins, SL. Cochrane Database of Systematic Reviews, vol. 1. Chichester: John Wiley & Sons, Ltd, 1996.Google Scholar
Fung, BM, Leon, DJ, Beck, LN, Tabibian, JH. Pre-procedural preparation and sedation for gastrointestinal endoscopy in patients with advanced liver disease. Dig Dis Sci. 2022;67(7):2739–53.CrossRefGoogle ScholarPubMed
Chawla, N, Boateng, A, Deshpande, R. Procedural sedation in the ICU and emergency department. Curr Opin Anaesthesiol. 2017;30(4):507–12.CrossRefGoogle ScholarPubMed
Odom-Forren, J, Watson, DS. Management of complications. In Practical Guide to Moderate Sedation/Anesthesia, 2nd ed. New York, NY: Mosby, 2005, 7196.Google Scholar
POM Medical procedural oxygen masks: adult male or female procedural oxygen mask - 1001-MF. Available at www.graylinemedical.com/products/pom-medical-procedural-oxygen-masks-adult-male-or-female-procedural-oxygen-mask-1001-mf?variantGoogle Scholar
Takahashi, S, Uemura, A, Nakayama, S, Miyabe, M, Toyooka, H. Bronchospasms and wheezing after induction of anesthesia with propofol in patients with a history of asthma. J Anesth. 2002;16(4):360–1.CrossRefGoogle ScholarPubMed
Bhattacharya, M, Kallet, RH, Ware, LB, Matthay, MA. Negative-pressure pulmonary edema. Chest. 2016;150(4):927–33.CrossRefGoogle ScholarPubMed
Tasch, MD. Pulmonary aspiration. In Atlee, JL, ed., Complications in Anesthesia, 2nd ed. Philadelphia, PA: Saunders/Elsevier, 2007, 186–8.Google Scholar
D’eramo, EM, Bookless, SJ, Howard, JB. Adverse events with outpatient anesthesia in Massachusetts. J Oral Maxillofac Surg. 2003;61(7):793800.CrossRefGoogle ScholarPubMed
Gan, TJ, Diemunsch, P, Habib, AS, et al. Consensus guidelines for the management of postoperative nausea and vomiting. Anesth Analg. 2014;118(1):85113.CrossRefGoogle ScholarPubMed
Stoops, S, Kovac, A. New insights into the pathophysiology and risk factors for PONV. Best Pract Res Clin Anaesthesiol. 2020;34(4):667–79.CrossRefGoogle ScholarPubMed
Guitton, C, Gabillet, L, Latour, P, et al. Propofol infusion syndrome during refractory status epilepticus in a young adult: successful ECMO resuscitation. Neurocrit Care Aug. 2011;15(1):139–45.Google Scholar
Ramos, JA, Brull, SJ. Psychogenic non-epileptic seizures in the post-anesthesia recovery unit. Brazilian J Anesthesiol. 2016;66(4):426–9.Google ScholarPubMed
Bray, RJ. Propofol infusion syndrome in children. Paediatr Anaesth. 1998;8(6):491–9.CrossRefGoogle ScholarPubMed
Wysowski, DK, Pollock, ML. Reports of death with use of propofol (Diprivan) for nonprocedural (long-term) sedation and literature review. J Am Soc Anesthesiol. 2006;105(5):1047–51.Google ScholarPubMed
Wong, JM. Propofol infusion syndrome. Am J Ther. 2010;17(5):487–91.CrossRefGoogle ScholarPubMed
Pisapia, JM, Wendell, LC, Kumar, MA, Zager, EL, Levine, JM. Lactate-to-pyruvate ratio as a marker of propofol infusion syndrome after subarachnoid hemorrhage. Neurocrit Care Aug. 2011;15(1):134–8.Google ScholarPubMed
Kane, GC, Hoehn, SM, Behrenbeck, TR, Mulvagh, SL. Benzocaine-induced methemoglobinemia based on the Mayo Clinic experience from 28 478 transesophageal echocardiograms: incidence, outcomes, and predisposing factors. Arch Intern Med. 2007; 167(18):1977–82.CrossRefGoogle Scholar
Adams, V, Marley, J, McCarroll, C. Prilocaine induced methaemoglobinaemia in a medically compromised patient. Was this an inevitable consequence of the dose administered? Br Dent J. 2007;203(10):585–7.CrossRefGoogle Scholar
Waring, JP, Baron, TH, Hirota, WK, et al. American Society for Gastrointestinal Endoscopy, guidelines for conscious sedation and monitoring during gastrointestinal endoscopy. Gastrointes Endosc. 2003;58(3):317–22.CrossRefGoogle ScholarPubMed
Mancuso, CE, Tanzi, MG, Gabay, M. Paradoxical reactions to benzodiazepines: literature review and treatment options. Pharmacotherapy. 2004;24(9):1177–85.CrossRefGoogle ScholarPubMed
Milam, SB, Bennett, CR. Physostigmine reversal of drug-induced paradoxical excitement. Int J Oral Maxillofac Surg. 1987;16(2):190–3.CrossRefGoogle ScholarPubMed

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