Objective

Minimal Sedation +++

Moderate/Conscious Sedation/ Analgesia

Deep Sedation/ Analgesia

General Anesthesia

Required Competence

Knowledge of agents, including reversal agents, order writing privileges, BLS.

Knowledge of agents, including reversal agents, order writing privileges, can manage a compromised airway, provide adequate oxygenation and ventilation.

Knowledge of agents, including reversal agents, order writing privileges, evidence of ability to manage cardiovascular instability as well as a compromised airway, provide adequate oxygenation and ventilation (Ambu bag, mask, nasal or oral airway).

See Department of Anesthesia P+P manual.

Consent

Plan for sedation discussed with patient/family.

Operative/procedure consent references sedation. In addition Hospital policy requires progress note saying risks, benefits and alternatives discussed and patient agrees.

Operative/procedure consent references sedation. In addition Hospital policy requires progress note saying risks, benefits and alternatives discussed and patient agrees.

Consent for Anesthesia (Hospital policy requires progress note saying RBA discussed and patient agrees).

Responsiveness

Normal response to verbal stimulation.

Purposeful response to verbal or tactile stimulation (reflex withdrawal from a painful stimulus is NOT a purposeful response).

Purposeful response following repeated or painful stimulation; may lose protective reflexes.

Unarousable even with painful stimulus.

Pre-assessment

Significant past and immediate history, prior sedation, meds on board, current level of responsiveness, allergies, weight, baseline vital signs.

Recent relevant Hx (R of S), focused physical (at least heart & lungs), current level of responsiveness, Hx prior adverse experience with sedation, airway assessment (include ability to hyper-extend neck and open mouth), allergies, weight. ASA status, re-assessment immediately prior to process. Reassessment vs/LOC immediately prior to sedation.

Recent relevant Hx (R of S), focused physical (at least heart & lungs), current level of responsiveness, Hx prior adverse experience with sedation, airway assessment (include ability to hyper-extend neck and open mouth), allergies, weight. ASA status, re-assessment immediately prior to process.

Reassessment vs/LOC immediately prior to sedation.

Standard pre-anesthesia assessment per Anesthesia Department policy. Reassessment vs/LOC immediately prior to induction.

Airway

Unaffected.

No intervention required.

Intervention/protection may be required.

Ambu/intubation may be required.

Spontaneous Ventilation

Unaffected.

Adequate.

May be inadequate.

Frequently inadequate.

Cardiovascular Function

Unaffected.

Usually maintained.

Usually maintained.

May be impaired.

Equipment

Access to resuscitation equipment.

Crash cart in immediate area including respiratory box, cardiac monitor, pulse ox, suction machine, IV in progress, reversal agents at hand.

Crash cart in immediate area including respiratory box, cardiac monitor, pulse ox, suction machine, IV in progress, reversal agents at hand.

Crash cart in immediate area including respiratory box, cardiac monitor, pulse ox, IV in progress.

Monitoring

Direct visual.

Cardiac rate and rhythm, BP, oxygen saturation, response to stimuli at least every 15 minutes.

Cardiac rate and rhythm, BP, oxygen saturation, response to stimuli every 5 minutes.

Cardiac rate and rhythm, BP, oxygen saturation, response to stimuli.

Reversal

Not usually required, but should have immediate access to drugs.

Not usually required, but should have immediate access to drugs.

Usually/frequently required; must have immediate access to drugs.

Usually required.

Reassessment

Patient response as evidenced in facial expression, muscle tension, verbalization, respiratory rate, etc.

Patient response as evidenced by cardiac rate, rhythm, O2 sat, ability to tolerate procedure, diaphoresis, response to stimuli, signs of allergy.

Patient response as evidenced by cardiac rate, rhythm, O2 sat, ability to tolerate procedure, diaphoresis, response to stimuli, signs of allergy.

See Department of Anesthesia P+P manual.

Documentation

Pre and post sedation status, drug, dose, route and evidence of response.

Drugs, dose, route, cardiac rate, rhythm, O2 sat, Ramsey or Aldrete score, +/- complications, use of reversal agents.

Drugs, dose, route, cardiac rate, rhythm, O2 sat, Ramsey or Aldrete score, +/- complications, use of reversal agents.

See Department of Anesthesia P+P manual.