J Korean Med Assoc.  2013 Apr;56(4):264-270. 10.5124/jkma.2013.56.4.264.

The current state of sedation outside the operating room

Affiliations
  • 1Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, College of Medicine, Seoul, Korea. p6c8s17@catholic.ac.kr

Abstract

The demand for sedation outside of the operating room for diagnostic or therapeutic procedures has recently been dramatically increasing. The Joint Commission International (JCI) is pressing domestic hospitals trying to obtain JCI certification to accept its sedation policies. This article aimed to investigate recent trends in sedation and suggest desirable directions for safe and high-quality sedation. The most active areas in research are procedural sedation, sedation in the intensive care unit (ICU), and pediatric sedation. Patient safety and performance of procedures without complications are the most important goals during sedation. According to the JCI regulation, noninvasive blood pressure, electrocardiography, pulse oximetry and capnography are the basic requirements, and sedation personnel should be separate from those who perform the procedure. Careful preprocedural assessment and tight intra-procedural monitoring for airway obstruction are critical in procedural sedation. Many merits of dexmedetomidine in procedural sedation have been reported despite its hemodynamic risks. Daily intermittent interruption is the main trend in ICU sedation providing better outcomes for mechanically ventilated patients. Analgosedation in the ICU is initial analgesia starting with remifentanil and later adding sedatives if required. Individual readjustment of the dosage using a sedation scoring system is a key requirement for successful results in ICU sedation. Ketofol, mixture of ketamine and propofol, has recently become popular for painful pediatric procedures. Pediatric sedation (especially for those < or = 3 years) with computed tomography or magnetic resonance imaging examination has a greater risk of hypoxia, but pediatric sedation experts are lacking. In conclusion, there is an urgent need for the nationwide establishment of standard sedation regulation, and securing or training sedation specialists.

Keyword

Sedation; Ambulatory surgery; Joint Commission on Accreditation
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