When to Call Anesthesiologists for Sedation

Abstract

Sedation is an essential component in various medical procedures, ensuring patient comfort, safety, and the successful completion of the procedures.1-3 Generally, mild and moderate sedation could be safely performed by the nonanesthetic personnel by using benzodiazepines and/or opioids.4 However, determining when to involve an anesthesiologist can be an important decision, dependent on the complexity of the procedure, the patient’s medical condition, and the depth of sedation level required. A physician who continues current advanced life support qualification and who is familiar with procedural sedation, must be immediately available during the sedation and after the procedure. This minireview article evaluates the key considerations for calling an anesthesiologist for assistance with sedation, highlighting the factors that necessitate their expertise and the guidelines that inform these decisions. Sedation could range from minimal sedation (anxiolysis) to general anesthesia. Several guidelines created by the American Society of Anesthesiologists (ASA)5 and the American Academy of Pediatrics6 developed the guidelines and definitions of procedural sedation. Minimal (mild) sedation: The patient is relaxed but fully awake and able to respond to verbal commands. Cardiorespiratory functions are unchanged. Minimal sedation does not invoke the monitoring requirements define in this policy. Cognitive function and coordination may be impaired. Moderate (conscious) sedation: The patient responds purposefully to verbal commands, either alone or accompanied by light tactile stimulation. No interventions are required to maintain a patent airway, and spontaneous ventilation is adequate. Deep sedation: The patient is not easily aroused but can respond purposefully after repeated or painful stimulation. The capacity to preserve respiratory function may be diminished. Additionally, the patient may necessitate support in maintaining the patent airway and spontaneous respiration may be insufficient. General anesthesia: The patient is not arousable, even with painful stimulation. The cardiorespiratory functions are usually reduced and the patients commonly demand the support in maintaining the airway. In addition, the positive pressure ventilations may be needed.