Procedural sedation and analgesia
The overall goal is to induce a decreased level of consciousness while maintaining the patient's ability to breathe on their own.
Common purposes include: There are no absolute reasons that immediately disqualify a patient from receiving PSA.
[citation needed] Although there is no age limit for PSA, the elderly have a greater chance of complications such as longer than intended sedation time, increased sensitivity to medications, adverse effects of medications, and higher than expected drug levels due to difficulty clearing the drugs.
[3] Patients with serious medical conditions are at greater chance for negative side effects after receiving PSA.
Use the ASA Classification to predict a patient's risk for serious complications from PSA, such as hypotension or respiratory depression.
Examples of a difficult airway include a thick neck/obese patient, head and neck structural abnormalities, and lung disease.
Measures such as reducing starting dose, giving drugs slowly, and redosing less frequently will not change risk of PSA complications in a patient with a difficult airway.
For this reason, a physician who is performing PSA should be prepared to care for a patient at least one level of sedation greater than that intended.
It causes profound amnesia but allows spontaneous respiration, cardiopulmonary stability, and airway reflexes are still intact.
Adverse effects to look out for include hypotension (low blood pressure) and respiratory depression, manifested as mild drops in oxygen saturation levels.
Side effects of etomidate include myoclonus (involuntary muscle jerking) and respiratory depression.
As a result, the elderly, the obese, and those with kidney or liver disease are more vulnerable to prolonged sedation with midazolam.
Other reported complications include fast heart rate, elevated blood pressure, nausea, vomiting, and laryngospasm, but usually in the context of oropharyngeal manipulation.
[8] Any patient undergoing anaesthesia must be pre-assessed for risk using a classification system, such as the one devised by the American Society of Anesthesiologists (ASA).
If the patient is ASA 3 or 4 additional resources might be needed, such as a person with more training in procedural sedation, an anesthesiologist.
Therefore, the anesthetist should perform an airway exam that includes a Mallampati score, mouth opening assessment, and Thyromental distance.
[4] It is important to keep track of the patient's vital signs, especially oxygen saturation and blood pressure [1] when giving PSA to ensure adequate cardiopulmonary function.
Depending on the how substantial the respiratory depression, the physician can use supplemental oxygen or other airway interventions to stabilize the patient.
There is a theoretical concern that performing PSA on a patient with food in their stomach can increase the risk of aspiration.
Currently, there is no evidence to suggest clinically significant risk of aspiration of stomach contents if performing PSA on a patient with recent food intake.
However, in the emergency department setting, PSA is usually administered without waiting the full six hours, unless there is clear evidence that the patient may not be able to maintain his/her airway on their own.
