Procedural sedation

Sedation and analgesia comprise a continuum of states ranging from minimal sedation (anxiolysis) through GA. Specially trained nurses provide sedation for the majority of procedures outside of the operating room for patients deemed ASA I and ASA II. Procedural sedation encompasses moderate sedation/analgesia, also known as conscious sedation (CS), and deep sedation. CS is defined as “a drug-induced depression of consciousness during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation. No interventions are required to maintain a patent airway, and spontaneous ventilation is adequate. Cardiovascular function is usually maintained” (American Society of Anesthesiologists. Continuum of depth of sedation definition of GA and levels of sedation/analgesia. October 23, 2019). Common medications include midazolam and fentanyl. Deep sedation occurs when a deeper level of consciousness is reached. Patients can be aroused with repeated painful stimuli. Airway manipulation may be needed, and unintended GA may occur. Deep sedation requires special privileges and providers in airway management. The American Society of Anesthesiologists (ASA) and Joint Commission on Accreditation of Healthcare Organizations and state agencies (licensing boards) have a set of guidelines for provisions of nonphysicians to deliver conscious and deep sedation.