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Procedural sedation in adults outside the operating room

Author
Robert L Frank, MD, FACEP
Section Editor
Allan B Wolfson, MD
Deputy Editor
Jonathan Grayzel, MD, FAAEM

INTRODUCTION

The practice of acute care medicine often requires the performance of procedures that can cause pain and anxiety. Procedural sedation reduces the discomfort, apprehension, and potential unpleasant memories associated with such procedures and facilitates performance of the procedure.

The practice of procedural sedation in adults, including monitoring and medications, will be reviewed here. Procedural sedation in children and the sedation required for lengthier procedures, such as colonoscopy, are discussed separately. (See "Procedural sedation in children outside of the operating room" and "Overview of procedural sedation for gastrointestinal endoscopy".)

DEFINITIONS

Procedural sedation involves the use of short-acting analgesic and sedative medications to enable clinicians to perform procedures effectively, while monitoring the patient closely for potential adverse effects. This process was previously (and inappropriately) termed "conscious sedation," but because effective sedation often alters consciousness, the preferred term is now "procedural sedation and analgesia" (PSA) [1].

The practice of providing sedation, once primarily the domain of anesthesia practitioners, is now routinely performed by other specialists, such as emergency clinicians, critical care specialists, and various nurse specialists [2].

Recognizing that PSA exists along a spectrum, the Joint Commission on Accreditation of Healthcare Organizations in the United States has attempted to define the levels of sedation, which range from minimal sedation to general anesthesia [3-5]. Common terms include the following:

                                  

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Literature review current through: Nov 2016. | This topic last updated: Tue Nov 22 00:00:00 GMT 2016.
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