Developed By: Committee on Quality Management and Departmental Administration
Last Amended: October 26, 2022 (Original Approval: October 20, 2010)
ASA believes that physician anesthesiologist participation in all deep sedation provides the safest patient care. ASA is concerned that individuals who are not anesthesia professionals may not recognize that sedation and general anesthesia are a continuum, and thus unintentionally deliver general anesthesia without having the training and experience to respond appropriately. However, ASA acknowledges that Medicare regulations provide for the administration and supervision of deep sedation by non-anesthesiologist physicians, oral surgeons, dentists, and podiatrists (“qualified non-anesthesia professionals”). This statement should guide the Director of Anesthesia Services (DAS) and those non-anesthesia professionals wishing to provide deep sedation.
There is a significant risk that patients undergoing deep sedation may slip into a state of general anesthesia as described in the American Society of Anesthesiologists Continuum of Depth of Sedation: Definition of General Anesthesia and Levels of Sedation/Analgesia. Loss of consciousness and the inability to respond purposefully define general anesthesia. The need to provide positive pressure ventilation or maintain the airway with an airway device are incidental to this definition. Individuals requesting privileges to administer deep sedation must demonstrate their ability to (1) recognize that a patient has entered a state of general anesthesia and (2) maintain a patient’s vital functions until the patient has been rescued from general anesthesia and returned to an appropriate level of sedation.
These recommendations apply to granting privileges to non-anesthesia personnel who wish to administer deep sedation in all surgical and procedural clinical settings.
The granting, reappraisal, and revision of clinical privileges must be awarded on a time-limited basis in accordance with rules and regulations of the health care facility, its medical staff, organizations accrediting the health care facility, and relevant local, state, and federal governmental agencies.
At the time of this statement’s publication, CMS defines in 42 CFR 482.52(a)1 those persons who are qualified by education, training, and licensure to administer deep sedation or supervise the administration of deep sedation by nurse anesthetists. Because training is procedure-specific, the type and complexity of procedures for which the qualified person may administer or supervise deep sedation must be specified in the privileges granted.
RESPONSIBILITIES OF THE CLINICIAN PROVIDING DEEP SEDATION
Any qualified person who administers and monitors deep sedation must be dedicated to that task. Therefore, the individual who administers and monitors deep sedation must be different from the individual performing the diagnostic or therapeutic procedure (see ASA Guidelines for Sedation and Analgesia by Non-anesthesiologists).
Non-anesthesiologist physicians may only delegate or supervise the administration or monitoring of deep sedation by individuals who are themselves qualified and trained to administer deep sedation and are able to recognize and rescue from general anesthesia.
Privileging for the administration of sedative and analgesic drugs to establish a level of deep sedation will require active participation in an ongoing process that evaluates the qualified person’s clinical performance and patient care outcomes through a formal facility program of continuous performance improvement. The facility’s deep sedation performance improvement program will be developed with oversight by the Director of Anesthesia Services.
American Society of Anesthesiologists. Guide to Anesthesia Department Administration. Suggested Curriculum for Deep Sedation Training.
American Society of Anesthesiologists. Continuum of Depth of Sedation: Definition of General Anesthesia and Levels of Sedation/Analgesia.
142 CFR 482.52 is available at https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-G/part-482/subpart-D/section-482.52 and was most recently amended Nov 27, 2007. The corresponding interpretive guidelines are available at https://www.hhs.gov/guidance/sites/default/files/hhs-guidance-documents/SCLetter11_10.pdf and were most recently updated Jan 14, 2011.
Curated by: Governance
Last updated by: Governance
Date of last update: October 26, 2022