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Adequate patient monitoring is essential for successful and safe practice of sedation. Monitoring must be performed by a designated healthcare provider and should be performed during all phases of the procedure. Healthcare providers should be familiar with monitoring equipment and be able to interpret the data obtained from it. Monitoring for sedation procedures primarily involves the observation of blood pressure, oxygenation, respiratory function, electrocardiography (ECG) and capnography tracings. Although patients undergoing sedation are not exposed to potent inhalation agents used for general anesthesia, the importance of temperature monitoring should not be underestimated. Patients undergoing minor surgical procedures are generally exposed to the ambient environment. The maximum concentration of carbon dioxide is reached at the end of exhalation, and then identified as end-tidal CO2 (ETCO2). During sedation, the use of crystalloid solutions is generally recommended for the intravenous replacement of fluids.
Certain patient populations provide challenging clinical situations for the sedation provider. Patients with cardiovascular disease, chronic obstructive pulmonary disease (COPD), chronic renal failure, obesity, or advanced age are considered high risk and possess a higher rate of procedural complications. This chapter discusses important features of these higher-risk patients and practice management when sedation is required. COPD is frequently found in patients with chronic bronchitis or emphysema. Common procedural complications in this patient population include hypoventilation (hypoxemia and hypercapnia) and bronchospasm. Bronchospasm manifests as wheezing, and it is commonly caused by an exacerbation of the patient's COPD, but an anaphylactoid reaction to a sedation medication should be ruled out. Patients with known coronary artery disease (CAD) who become oversedated experience cardiac complications related to hypotension and/or hypoxemia. Medication used for sedation should be titrated in slowly, carefully watching hemodynamic response to the medication.
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