J Korean Med Assoc.  2013 Apr;56(4):285-291. 10.5124/jkma.2013.56.4.285.

Issues in procedural sedation outside the operating theater: characteristics and safety of commonly used sedatives and analgesics

Affiliations
  • 1Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea. seaoyster@yuhs.ac.kr

Abstract

With increasing interest towards the proper management of the patient's anxiety and pain during diagnostic and therapeutic procedures, adequate sedation has become an essential part of a successful procedure. Due to recent advancements in modern medicine, many surgical procedures that were once done under general anesthesia are being increasingly replaced by minimally invasive procedures that are performed under sedation. However, the duration or degrees of pain that are caused by different types of procedures vary extensively. Some procedures are easily done under only light sedation, while others require extensive pain control and deeper sedation. Comfort and safety are essential components of 'successful sedation', and full understanding of the degree of pain and the physiologic changes that the procedure may cause is needed in order to offer this to the patient. The depth of sedation should be controlled with proper sedatives while adequate analgesia should be offered according to type of procedure. Choice and doses of drugs should always be tailored to the patient's general condition, and additional administrations should be done after the effect of the previous dose is observed in order to avoid overdosing. When combining sedatives and/or analgesics, the possible synergistic effects between different drugs should always be kept in mind. In order to choose the adequate type and dose of drug, knowledge regarding the pharmacodynamic and pharmacokinetic properties of commonly used drugs for procedures is needed for safe and effective sedation.

Keyword

Analgesics; Conscious sedation; Patient safety; Hypnotics and sedatives

MeSH Terms

Analgesia
Analgesics
Anesthesia, General
Anxiety
Conscious Sedation
History, Modern 1601-
Humans
Hypnotics and Sedatives
Light
Patient Safety
Analgesics
Hypnotics and Sedatives

Cited by  1 articles

Medical Dispute Related to Gastrointestinal Endoscopy Complications: Prevention and Management
Yunho Jung
Korean J Gastroenterol. 2019;73(6):315-321.    doi: 10.4166/kjg.2019.73.6.315.


Reference

1. Seip B, Huppertz-Hauss G, Sauar J, Bretthauer M, Hoff G. Patient's satisfaction: an important factor in quality control of gastroscopies. Scand J Gastroenterol. 2008. 43:1004–1011.
Article
2. Park CH, Min JH, Yoo YC, Kim H, Joh DH, Jo JH, Shin S, Lee H, Park JC, Shin SK, Lee YC, Lee SK. Sedation methods can determine performance of endoscopic submucosal dissection in patients with gastric neoplasia. Surg Endosc. 2013. 02. 07. [Epub]. DOI: 10.1007/s00464-013-2804-z.
Article
3. American Society of Anesthesiologists Task Force on Sedation and Analgesia by Non-Anesthesiologists. Practice guidelines for sedation and analgesia by non-anesthesiologists. Anesthesiology. 2002. 96:1004–1017.
4. Reves JG, Glass PS, Lubarsky DA, McEvoy MD, Martinez-Ruiz R. Miller RD, Eriksson LI, Fleisher LA, Wiener-Kronish JP, Young WL, editors. Intravenous anesthetics. Miller's Anesthesia. 2009. 7th ed. Philadelphia: Elsevier Churchill Livingstone;719–768.
Article
5. Kanto JH. Midazolam: the first water-soluble benzodiazepine. Pharmacology, pharmacokinetics and efficacy in insomnia and anesthesia. Pharmacotherapy. 1985. 5:138–155.
Article
6. Cohen LB, Wecsler JS, Gaetano JN, Benson AA, Miller KM, Durkalski V, Aisenberg J. Endoscopic sedation in the United States: results from a nationwide survey. Am J Gastroenterol. 2006. 101:967–974.
Article
7. Training Committee. American Society for Gastrointestinal Endoscopy. Training guideline for use of propofol in gastroin-testinal endoscopy. Gastrointest Endosc. 2004. 60:167–172.
8. Perel A. Non-anaesthesiologists should not be allowed to administer propofol for procedural sedation: a Consensus Statement of 21 European National Societies of Anaesthesia. Eur J Anaesthesiol. 2011. 28:580–584.
Article
9. Lamond DW. Review article: safety profile of propofol for paediatric procedural sedation in the emergency department. Emerg Med Australas. 2010. 22:265–286.
Article
10. Faigel DO, Baron TH, Goldstein JL, Hirota WK, Jacobson BC, Johanson JF, Leighton JA, Mallery JS, Peterson KA, Waring JP, Fanelli RD, Wheeler-Harbaugh J. Standards Practice Committe, American Society for Gastrointestinal Endoscopy. Guidelines for the use of deep sedation and anesthesia for GI endoscopy. Gastrointest Endosc. 2002. 56:613–617.
Article
11. Keating GM, Hoy SM, Lyseng-Williamson KA. Dexmedetomidine: a guide to its use for sedation in the US. Clin Drug Investig. 2012. 32:561–567.
Article
12. McQuaid KR, Laine L. A systematic review and meta-analysis of randomized, controlled trials of moderate sedation for routine endoscopic procedures. Gastrointest Endosc. 2008. 67:910–923.
Article
13. Latta KS, Ginsberg B, Barkin RL. Meperidine: a critical review. Am J Ther. 2002. 9:53–68.
Article
14. Fukuda K. Miller RD, Eriksson LI, Fleisher LA, Wiener-Kronish JP, Young WL, editors. Opioids. Miller's anesthesia. 2009. 7th ed. Philadelphia: Elsevier Churchill Livingstone;769–824.
Article
15. Servin FS, Billard V. Remifentanil and other opioids. Handb Exp Pharmacol. 2008. 182:283–311.
Article
Full Text Links
  • JKMA
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr