Stable angina, diabetes with hyperglycaemia, moderate chronic obstructive pulmonary disease Table 1: American Society of Anesthesiologists Physical Status Classification The 2012 report and recommendations by the Royal College of Anaesthetists and RCEM Safe Sedation of Adults in the Emergency Department covers deeper levels of sedation 2.
Safe sedation of children is covered in Paediatric EM Practical procedures for ST4-6. The knowledge and skill competencies expected are listed in table 2. Not included in the classification is ‘dissociative sedation’, uniquely produced by ketamine it is a trance like cataleptic state characterized by profound analgesia and amnesia, with retention of protective airway reflexes, spontaneous respirations & cardiopulmonary stability.Ī core clinical learning outcome of the 2015 RCEM curriculum for CT1 and CT2 is the provision of safe and effective sedation to ASA 1 and 2 1 adult patients (table 1), aged less than 80 years of age using a maximum of two short acting agents. Cardiovascular function may also be impaired. Patients require assistance in maintaining a patent airway, and positive pressure ventilation may be required because of depressed spontaneous ventilation or drug-induced depression of neuromuscular function. The ability to independently maintain ventilatory function is often impaired. General Anaesthesia is a drug-induced loss of consciousness during which patients are not rousable, even by painful stimulation.Cardiovascular function is usually maintained. Patients may require assistance in maintaining a patent airway, and spontaneous ventilation may be inadequate. The ability to independently maintain ventilatory function may be impaired. Deep Sedation/Analgesia is a drug-induced depression of consciousness during which patients cannot be easily aroused but respond purposefully following repeated or painful stimulation.In the Emergency Department this is most often achieved using a combination of opioids and benzodiazepines. No interventions are required to maintain a patent airway, and spontaneous ventilation is adequate. Moderate Sedation/Analgesia (‘Conscious Sedation’) is a drug-induced depression of consciousness during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation.Although cognitive function and coordination may be impaired, ventilatory and cardiovascular functions are unaffected. Minimal Sedation (Anxiolysis) is a drug-induced state during which patients respond normally to verbal commands.The American Society of Anesthesiologists (ASA) uses the following useful definitions for sedation:
Sedation and recovery move patients along this scale, but it is difficult to accurately assess the precise degree of sedation at any one time, and even harder to maintain a patient at a pre-defined target level. Sedation is a continuum which extends from a normal conscious level to being fully unresponsive. The aim is clear: make the procedural experience as comfortable as possible for your patient, whilst ensuring that your practice is safe. Sedation is a routine aspect of emergency care.
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