Sedation and monitoring

Published on 12/06/2015 by admin

Filed under Radiology

Last modified 12/06/2015

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Sedation and monitoring

Sedation

Sedation is the use of a drug or drugs to produce a state of depression of the central nervous system that enables interventional procedures or treatment to be carried out. Sedative drugs may be combined with drugs used for pain relief (analgesia). Sedation is only part of a ‘package’ of care comprising pre-assessment, properly informed consent, adequate facilities, good techniques and risk avoidance.1

Over recent years the number and complexity of diagnostic imaging and image-guided interventional procedures in radiology departments has increased; often these patients are frail, medically unfit, unable to cooperate or lie still. The relief of anxiety, discomfort and pain allows patients to tolerate these procedures. Some drugs, such as benzodiazepines, have purely sedative effects but others, such as opioids, have combined sedative and analgesic effects. Although sedative and analgesic agents are generally safe, catastrophic complications related to their use can occur, often as a result of incorrect drug administration or inadequate patient monitoring.2 The incidence of adverse outcomes is reduced by improved understanding of the pharmacology of drugs used, appropriate monitoring of sedated patients and by recognizing those at increased risk of adverse event.

There is a continuum between the main types of sedation (Fig. 18.1) defined as:

The joint Royal College of Radiologists/Royal College of Anaesthetists Working Party on Sedation and Anaesthesia in Radiology recommended establishment of local guidelines for sedation in radiology.3 These should include:

Drugs

As part of a sedation protocol the following may be used: