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Complication of
Sedation
Complication of
SedationMohammad Daghistani M.B. B.S., FRCPC
Chairman Anesthesiology Department KAMC-Jeddah NGHA WR.
Mohammad Daghistani M.B. B.S., FRCPCChairman Anesthesiology Department KAMC-Jeddah NGHA WR.
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High risk patients
The elderly
Hepatic disorders
Renal disorders
Respiratory disorders
Cardiac disorders
Drug abusers
Obese patients
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Monitoring
Vigilant monitoring is the key to
prevention of overdose and other
potential complications
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Sedation
Sedation failure:
Could be due to unsuitability of the patient
or
Problems with medications
Excessive sedation
Can be avoided by:
Monitoring level of consciousness(i.e Ramsey score)
Titration of medications
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Respiratory depression &
hypoventilation
Detected by:
Decrease in oxygen saturation
Decrease in rate and depth of respirations
Treatment:
Stimulate patient
Open airway
Give oxygen
If the above steps are unsuccessful,ventilate with ambu-bag. If
the condition does not improve or the patient stops breathing,
intubate.
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Cardiac complications &
hypotension
Treatment: IV fluids
Oxygen
Vasopressors or specificagonists(avoid if possible)
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In conclusion
If patient and medication selection isappropriate and the patient is monitored
adequately, then the incidence of
complications due to
sedation/analgesia will be very low.
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Staff Qualification &
PrivilegingMohammad Daghistani M.B. B.S., FRCPC
Chairman Anesthesiology Department KAMC-Jeddah NGHA WR.
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Sedation policies &
procedure identify:
Special qualifications or skills of staffinvolved in sedation process
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Sedation Provider
Any physician who is privileged.
Anesthesiologists by nature of theirspecialty.
Physician or dentist who is credentialedor privileged.
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The Sedation Provider should
be competent in:
Techniques of various modes of sedation
Appropriate monitoring
Response to complications
Use of reversal agents At least basic life support
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Privileging of non-
Anesthesiologists Valid BLS Certification.
Documented attendance and successful
completion of an approvedSedation/Analgesia Course.
Training curriculum clearly indicating that
competency in providingSedation/Analgesia is part of the
qualification process for his/her degree.
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Privileging of non-
Anesthesiologists Certificates of experience from his/herChairman or previous employer
documenting that provision of
Sedation/Analgesia is part of his/her clinical practice for a minimum of 5yrs.
Attending and passing the Basic
Competency Course provided by theHospital Sedation Committee.
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Privileging of non-
Anesthesiologists Re-evaluation of Privileging on individualbasis is mandated if:
Invalid BLS.
Less than 10 sedation/proceduresper year.
Failure to pass the basic competencycourse provided by the Hospital
Sedation Committee.
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Responsibilities of
Sedation Provider Obtain Consent Evaluate patient prior to procedure
Document the assessment
Refer to Anesthesia Department if needed
Prescribe or administer medications as per his/her privilege
Ensure monitoring of patients progress
Present in procedure area throughout the entire procedure and remainon the premises of recovery area during recovery.
Ensure appropriate discharge of patient.
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Competencies required for
Registered Nurse The nurse is competent in patient
monitoring, drug administration, and
protocols for dealing with emergencysituations
The nurse will have NO other
responsibilities that would leave thepatient unattended or compromise
continuous monitoring.
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Competencies required for
Registered Nurse The Nurse is able to demonstrate therequired knowledge of Pharmacology,
and complications related to medications.
Demonstrate monitoring requirementsduring sedation and recovery.
Understand the principles of oxygen
delivery, respiratory physiology, transportand uptake, and demonstrate the ability
to use oxygen delivery devices.
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Competencies required for
Registered Nurse Anticipate and recognize potentialcomplications of sedation in relation to
the type of medication being
administered.
Possess the requisite knowledge andskills to assess, diagnose and intervene
in the event of complications or undesired outcomes and to institute
nursing interventions in compliance with
orders.
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Competencies required for
Registered Nurse Demonstrate skill in airway management
and resuscitation principles.
The Nursing Education Department willmaintain an educational/competency
validation mechanism that includes
demonstration of the knowledge, skill and
abilities related to the management of
patients receiving sedation/analgesia.
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Privileging for Registered
Nurse The Registered Nurse needs to have avalid:
BLS certificate IV Cannulation workshop
ECG workshop
Sedation and Analgesia workshop
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The Registered Nurse is
Responsible for:
Providing uninterrupted monitoring of thepatients physiological parameters
Assisting in supportive or resuscitation
measures.
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