Journal List > J Korean Med Assoc > v.63(1) > 1141001

Min: Easy sedation anesthesia guide for non-anesthetic medical personnel

Abstract

Currently, sedation anesthesia is increasingly used in many medical fields, from gastroscopy to medical imaging. The demand for sedation anesthesia is expected to increase gradually with increasing number of day surgeries and increased expectations from medical services. The demand for sedation anesthesia is considerably higher than the available pool of anesthesiologists; therefore, in a significant number of cases, sedation anesthesia is induced by non-anesthesiologists. However, there is no systematic provision of education or expertise for non-anesthesiologists in delivering sedation anesthesia. In cases of non-anesthesiologists inducing anesthesia, social controversy is often caused by medical accidents and substance abuse. In this review, I have briefly summarized what non-anesthesiologists should know about sedation anesthesia and have presented guidelines simplifying sedation anesthesia for non-anesthesia medical personnel.

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Figure 1.
Modified Mallampati classification. Class I: soft palate, fauces, uvula, pillars are visible. Class II: soft palate, fauces, the part of uvula are visible. Class III: soft palate, the bottom of uvula are visible. Class IV: only hard palate is visible. Bair AE, Caravelli R, Tyler K, Laurin EG. Feasibility of the preoperative Mallampati airway assessment in emergency department patients. J Emerg Med 2010;38:677-680. Illustration by Min TJ.
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Figure 2.
Anesthetic depth measuring systems. (A) Bispectral index, (B) entropy, (C) schematic diagram for sedation depth, and (D) autonomic indicators.
jkma-63-36f2.tif
Figure 3.
End-tidal CO2 monitoring device. (A) Mask end-tidal CO2 monitoring device. (B) Nasal prong end-tidal CO2 monitoring device. Illustration by Min TJ.
jkma-63-36f3.tif
Figure 4.
Airway secure maneuvers. (A) Head tilt chin-lift maneuver. (B) Jaw-thrust maneuver. Pratice Paramedicine, July 5, 2018. Illustration by Min TJ.
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Figure 5.
Airway secure devices. (A) Oral airway. (B) Nasal airway. (C) Laryngeal mask.
jkma-63-36f5.tif
Table 1.
Preliminary checklist for patient sedation
Items Preparations
Pre-sedative patient evaluation Patient evaluation
 Airway, cardiopulmonary, renal, etc.
Description of patients and guardians
 Informed consent for each documents
Monitoring and airway devices Oxygen
Facial mask
Nasal cannula
Suction device, Suction catheter
End-tidal CO2 monitoring device
Pulse oxymetry
Other patient monitoring devices
Electrocardiography
Blood pressure
Pillow
Airway devices (oral, nasal)
Tracheal intubation devices (laryngoscopy, tubes, etc.)
Intravenous catheter, fluids
Drugs Sedatives (midazolam, propofol, dexmedetomidine, etc.)
Analgesics (alfentanil, remifentanil, ketamine, etc.)
Others (lidocaine, glycopyrrolate, etc.)
Drug delivery device Automated control sedation Syringe Continuous infusion device
Target-controlled infusion device
Patient control sedation Patient controlled sedation device
Table 2.
Fasting time recommendation
Digestive contents Minimum fasting period (hr)
Water without additives 2
Motherʼs milk 4
Baby food 6
Milk 6
Light meal 6
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