Practice Guidelines for Sedation and Analgesia by Non-Anesthesiologists: A Report by the American Society of Anesthesiologists Task Force on Sedation and Analgesia by Non-Anesthesiologists

Abstract

Developed by the Task Force on Sedation and Analgesia by Non-Anesthesiologists: Jeffrey B. Gross, M.D. (Chair), Farmington, Connecticut; Peter L. Bailey, M.D., Salt Lake City, Utah; Robert A. Caplan, M.D., Seattle, Washington; Richard T. Connis, Ph.D. (Methodologist), Woodinville, Washington; Charles J. Cote, M.D., Chicago, Illinois; Fred G. Davis, M.D., Burlington, Massachusetts; Burton S. Epstein, M.D., Washington, D.C.; Patricia A. Kapur, M.D., Los Angeles, California; John M. Zerwas, M.D., Houston, Texas; and Gregory Zuccaro, Jr., M.D., Cleveland, Ohio.Accepted for publication November 28, 1995. Supported by the American Society of Anesthesiologists, under the direction of James F. Arens, M.D., Chairman of the Committee on Practice Parameters. Approved by the House of Delegates, October 25, 1995. These guidelines received official endorsement by the Governing Board of the American Society for Gastrointestinal Endoscopy. A list of the references used to develop these guidelines is available by writing to the American Society of Anesthesiologists.Address correspondence to Dr. Gross: Department of Anesthesiology (M/C 2015), University of Connecticut School of Medicine, Farmington, Connecticut 06030-2015.Address reprint requests to the American Society of Anesthesiologists: 520 North Northwest Highway, Park Ridge, Illinois 60068-2573.Click on the links below to access all the ArticlePlus for this article.Please note that ArticlePlus files may launch a viewer application outside of your web browser.Key words: Analgesia. Practice guidelines: analgesia; sedation. Sedation: conscious.ANESTHESIOLOGISTS possess specific expertise in the pharmacology, physiology, and clinical management of patients receiving sedation and analgesia. For this reason, they are frequently called on to participate in the development of institutional policies and procedures for sedation and analgesia in nonoperating-room settings. To assist in this process, the American Society of Anesthesiologists developed these Guidelines for Sedation and Analgesia by Non-Anesthesiologists.Practice guidelines are systematically developed recommendations that assist practitioners in making decisions about health care. These recommendations may be adopted, modified, exceeded, or rejected according to clinical needs and constraints, and they are subject to periodic revision as warranted by the evolution of medical knowledge, technology, and practice. Practice guidelines are not intended as standards or absolute requirements, and their use cannot guarantee any specific outcome.The practice guidelines enumerated below have been developed using systematic literature summarization techniques. Results of the literature analyses have been supplemented by the opinions of the Task Force members and a panel of more than 60 consultants, drawn from a variety of medical specialties in which sedation and analgesia are commonly provided. In those instances when the literature does not provide conclusive data, there is an explicit statement that the guidelines are based on the opinion of the consultants or the consensus of the Task Force members. A detailed description of the analytic methods is included in appendix 1.A. Definition"Sedation and analgesia" describes a state that allows patients to tolerate unpleasant procedures while maintaining adequate cardiorespiratory function and the ability to respond purposefully to verbal command and/or tactile stimulation. The Task Force decided that the term "sedation and analgesia" (sedation/analgesia) more accurately defines this therapeutic goal than does the commonly used but imprecise term "conscious sedation." Note that patients whose only response is reflex withdrawal from a painful stimulus are sedated to a greater degree than encompassed by "sedation/analgesia."B. PurposeThe purpose of these guidelines is to allow clinicians to provide their patients with the benefits of sedation/analgesia while minimizing the associated risks. Sedation/analgesia provides two general types of benefit: First, sedation/analgesia allows patients to tolerate unpleasant procedures by relieving anxiety, discomfort, or pain. Second, in children and uncooperative adults, sedation/analgesia may expedite the conduct of procedures that are not particularly uncomfortable but require that the patient not move. Excessive sedation/analgesia may result in cardiac or respiratory depression that must be rapidly recognized and appropriately managed to avoid the risk of hypoxic brain damage, cardiac arrest, or death. Conversely, inadequate sedation/analgesia may result in undue patient discomfort or patient injury because of lack of cooperation or adverse physiologic response to stress.C. FocusThese guidelines have been designed to be applicable to procedures performed in a variety of settings (e.g., hospitals, free-standing clinics, physicians' offices) by practitioners who are not specialists in anesthesiology. The guidelines specifically exclude the