Easy sedation anesthesia guide for non-anesthetic medical personnel

Too Jae Min

doi:10.5124/jkma.2020.63.1.36

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

Pharmacotherapeutics

J Korean Med Assoc 2020;63(1):36-44.

Published online: 17 January 2020

DOI: https://doi.org/10.5124/jkma.2020.63.1.36

Easy sedation anesthesia guide for non-anesthetic medical personnel

Too Jae Min, MD

Department of Anesthesiology and Pain Medicine, Korea University Ansan Hospital, Ansan, Korea

Corresponding author: Too Jae Min E-mail: minware2@korea.ac.kr

Revised 11 November 2019 Accepted 25 November 2019

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Hypnotics and sedatives, Propofol, Etomidate, Dexmedetomidine, Ketamine

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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.

Figure 2.

Anesthetic depth measuring systems. (A) Bispectral index, (B) entropy, (C) schematic diagram for sedation depth, and (D) autonomic indicators.

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.

Figure 4.

Airway secure maneuvers. (A) Head tilt chin-lift maneuver. (B) Jaw-thrust maneuver. Pratice Paramedicine, July 5, 2018. Illustration by Min TJ.

Figure 5.

Airway secure devices. (A) Oral airway. (B) Nasal airway. (C) Laryngeal mask.

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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