Stanford Hospital And Clinics OR REGION DISCHARGE CRITERIA FOR PHASE I & II- POST ANESTHESIA CARE ORAM D 4.05 Issued: 10/02 Last revision/review: 4/10 2 A. A PATIENT TRANSPORTED TO THE PACU SHALL BE ACCOMPANIED BY A MEMBER OF THE ANESTHESIA CARE TEAM WHO IS KNOWLEDGEABLE ABOUT THE PATIENTS CONDITION. Our facility has a phase 1 which is immediately from the O.R. Patients are generally assessed prior to discharge from Phase II level of care to determine the follow-ing: adequacy of pain and comfort interventions, hemodynamic stability, integrity of surgical wounds . Able to be applied by knowledgeable health care providers, 1. Preferred reporting items of systematic reviews and meta-analyses. The PACU team cares for patients in all age ranges and all levels of acuity including ambulatory, inpatient, and critical care. These are ASPAN standards and we follow them. The patient would stay in phase II while being monitored, being treated for any issues like decreased urine output, pain, etcOnce the patient has finished being recovered he would be transported to the floor. There is a difference of opinion in our unit as to what ASPAN is stating in describing Phase I and Phase II level of care. hb``e`` Approved by the American Association of Oral and Maxillofacial Surgeons on September 23, 2017; the American College of Radiology on October 5, 2017; the American Dental Association on September 21, 2017; the American Society of Dentist Anesthesiologists on September 15, 2017; and the Society of Interventional Radiology on September 15, 2017. They are intended to encourage quality patient care, but cannot guarantee any specific patient outcome. Applied when patient is admitted to PACU as part of nursing assessment, 3. Available at: http://www.asahq.org/quality-and-practice-management/practice-guidance-resource-documents/standards-for-basic-anesthetic-monitoring. sIm;O@=@ When available, category A evidence is given precedence over category B evidence for any particular outcome. The PACU team cares for patients in all age ranges and all levels of acuity including ambulatory, inpatient, and critical care. Because minimal sedation (anxiolysis) may entail minimal risk, the guidelines specifically exclude it. %%EOF The PACU team cares for patients in all age ranges and all levels of acuity including ambulatory, inpatient, and critical care. Scientific evidence used in the development of these guidelines is based on cumulative findings from literature published in peer-reviewed journals. 1. 414 0 obj <>stream These guidelines specifically apply to the level of sedation corresponding to moderate sedation/analgesia (previously called conscious sedation), which is defined as a drug-induced depression of consciousness during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation. One respondent (1.92%) estimated a decrease in the amount of time they would spend on a typical case. These guidelines were developed by an ASAappointed task force of 13 members, consisting of physician anesthesiologists in both private and academic practices from various geographic areas of the United States, a cardiologist, a dentist anesthesiologist, an oral/maxillofacial surgeon, a radiologist, an ASA staff methodologist, and two consulting methodologists for the ASA Committee on Standards and Practice Parameters. 3) A post-anesthesia note is completed by an Anesthesia provider for all patients who d```n Discharge score attained within acceptable range set by policy. Standard V: Physician is responsible for the discharge of the patient from the post anesthesia care unit. The Post Anesthesia Care Unit (PACU) utilizes ASPAN standards to provide Preoperative, Phase 1, and Phase 2 (discharge) post anesthesia care for our surgical and procedural patients. The use of hypnosis in gastroscopy: A comparison with intravenous sedation. The guidelines encourage vigilance in the PACU for the common postoperative complications and appropriate treatment when such complications arise. Efficacy and safety of intravenous propofol sedation during routine ERCP: A prospective, controlled study. In this scenario we are not sure what the "extended level of care" might be. The literature is insufficient to determine whether monitoring patients level of consciousness improves patient outcomes or decreases risks. Titrated sedation with propofol or midazolam for flexible bronchoscopy: A randomised trial. . Statistically significant (P < 0.01) outcomes are designated as either beneficial (B) or harmful (H) for the patient; statistically nonsignificant findings are designated as equivocal (E). The three most common types were: (1) need for upper airway support. Specializes in NICU, PICU, Transport, L&D, Hospice. The standards are, at times, vague (e.g., standard #1 below) and can certainly be. FQ"bNJ,p*113W|&)( "9#~LwW 34 DOgp> Any patient having a diagnostic or therapeutic procedure for which moderate sedation is planned, Patients in whom the level of sedation cannot reliably be established, Patients who do not respond purposefully to verbal or tactile stimulation (e.g., stroke victims, neonates), Patients in whom determining the level of sedation interferes with the procedure, Principal procedures (e.g., upper endoscopy, colonoscopy, radiology, ophthalmology, cardiology, dentistry, plastics, orthopedic, urology, podiatry), Diagnostic imaging (radiological scans, endoscopy), Minor surgical procedures in all care areas (e.g., cardioversion), Pediatric procedures (e.g., suture of laceration, setting of simple fracture, lumbar puncture, bone marrow with local, magnetic resonance imaging or computed tomography scan, routine dental procedures), Pediatric cardiac catheterization (e.g., cardiac biopsy after transplantation), Obstetric procedures (e.g., labor and delivery), Procedures using minimal sedation (e.g., anxiolysis for insertion of peripheral nerve blocks, local or topical anesthesia), Procedures where deep sedation is intended, Procedures where general anesthesia is intended, Procedures using major conduction anesthesia (i.e., neuraxial anesthesia), Procedures using sedatives in combination with regional anesthesia, Nondiagnostic or nontherapeutic procedures (e.g., postoperative analgesia, pain management/chronic pain, critical care, palliative care), Settings where procedural moderate sedation may be administered, Radiology suite (magnetic resonance imaging, computed tomography, invasive), All providers who deliver moderate procedural sedation in any practice setting, Physician anesthesiologists and anesthetists, Nursing personnel who perform monitoring tasks, Supervised physicians and dentists in training, Preprocedure patient evaluation and preparation, Medical records review (patient history/condition), Nonpharmaceutical (e.g., nutraceutical) use, Focused physical examination (e.g., heart, lungs, airway), Consultation with a medical specialist (e.g., physician anesthesiologist, cardiologist, endocrinologist, pulmonologist, nephrologist, obstetrician), Preparation of the patient (e.g., preprocedure instruction, medication usage, counseling, fasting), Level of consciousness (e.g., responsiveness), Observation (color when the procedure allows), Continual end tidal carbon dioxide monitoring (e.g., capnography, capnometry) versus observation or auscultation, Plethysmography versus observation or auscultation, Contemporaneous recording of monitored parameters, Presence of an individual dedicated to patient monitoring, Creation and implementation of quality improvement processes, Supplemental oxygen versus room air or no supplemental oxygen, Method of oxygen administration (e.g., nasal cannula, face masks, specialized devices (e.g., high-flow cannula), Presence of individual(s) capable of establishing a patent airway, positive pressure ventilation and resuscitation (i.e., advanced life-support skills), Presence of emergency and airway equipment, Types of airway devices (e.g., nasal cannula, face masks, specialized devices (e.g., high-flow cannula), Supraglottic airway (e.g., laryngeal mask airway), Presence of an individual to establish intravenous access, Intravenous access versus no intravenous access, Sedative or analgesic medications not intended for general anesthesia, Dexmedetomidine versus other sedatives or analgesics, Sedative/opioid combinations (all routes of administration), Benzodiazepines combined with opioids versus benzodiazepines, Benzodiazepines combined with opioids versus opioids, Dexmedetomidine combined with other sedatives or analgesics versus dexmedetomidine, Dexmedetomidine combined with other sedatives or analgesics versus other sedatives or analgesics (alone or in combination), Intravenous versus nonintravenous sedative/analgesics not intended for general anesthesia (all non-IV routes of administration, including oral, nasal, intramuscular, rectal, transdermal, sublingual, iontophoresis, nebulized), Titration versus single dose, repeat bolus, continuous infusion, Sedative/analgesic medications intended for general anesthesia, Propofol alone versus nongeneral anesthesia sedative/analgesics alone, Propofol alone versus nongeneral anesthesia sedative/analgesic combinations, Propofol combined with nongeneral anesthesia sedative/analgesics versus propofol alone, Propofol combined with nongeneral anesthesia sedative/analgesics versus nongeneral anesthesia sedative/analgesics (alone or in combination), Propofol alone versus other general anesthesia sedatives (alone or in combination), Propofol combined with sedatives intended for general anesthesia versus other sedatives intended for general anesthesia (alone or in combination), Propofol combined with other sedatives intended for general anesthesia versus propofol (alone or in combination), Ketamine alone versus nongeneral anesthesia sedative/analgesics alone, Ketamine alone versus nongeneral anesthesia sedative/analgesic combinations, Ketamine combined with nongeneral anesthesia sedative/analgesics versus ketamine alone, Ketamine combined with nongeneral anesthesia sedative/analgesics versus nongeneral anesthesia sedative/analgesics (alone or in combination), Ketamine alone versus other general anesthesia sedatives (alone or in combination), Ketamine combined with sedatives intended for general anesthesia versus other sedatives intended for general anesthesia (alone or in combination), Ketamine combined with other sedatives intended for general anesthesia versus ketamine (alone or in combination), Etomidate alone versus nongeneral anesthesia sedative/analgesics alone, Etomidate alone versus nongeneral anesthesia sedative/analgesic combinations, Etomidate combined with nongeneral anesthesia sedative/analgesics versus etomidate alone, Etomidate combined with nongeneral anesthesia sedative/analgesics versus nongeneral anesthesia sedative/analgesics (alone or in combination), Etomidate alone versus other general anesthesia sedatives (alone or in combination), Etomidate combined with sedatives intended for general anesthesia versus other sedatives intended for general anesthesia (alone or in combination), Etomidate combined with other sedatives intended for general anesthesia versus etomidate (alone or in combination), Intravenous versus nonintravenous sedatives intended for general anesthesia, Titration of sedatives intended for general anesthesia, Naloxone for reversal of opioids with or without benzodiazepines, Intravenous versus nonintravenous naloxone, Flumazenil for reversal or benzodiazepines with or without opioids, Intravenous versus nonintravenous flumazenil, Continued observation and monitoring until discharge, Major conduction anesthetics (i.e., neuraxial anesthesia), Sedatives combined with regional anesthesia, Premedication administered before general anesthesia, Interventions without sedatives (e.g., hypnosis, acupuncture), New or rarely administered sedative/analgesics (e.g., fospropofol), New or rarely used monitoring or delivery devices, Improved pain management (i.e., pain during a procedure), Reduced frequency/severity of sedation-related complications, Unintended deep sedation or general anesthesia, Conversion to deep sedation or general anesthesia, Unplanned hospitalization and/or intensive care unit admission, Unplanned use of rescue agents (naloxone, flumazenil), Need to change planned procedure or technique, Prospective nonrandomized comparative studies (e.g., quasiexperimental, cohort), Retrospective comparative studies (e.g., case-control), Observational studies (e.g., correlational or descriptive statistics). The trauma of an operation and the residual effects of anesthetic drugs alter human physiology in predictable ways. Preprocedure patient preparation consists of (1) consultation with a medical specialist when needed; (2) patient preparation for the procedure (e.g., informing patients of the benefits and risks of sedatives and analgesics, preprocedure instruction, medication usage, counseling); and (3) preprocedure fasting from solids and liquids. Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window). Reported by authors as oxygen desaturation to at most 95% or oxygen desaturation more than 5 or 10% below baseline. A prospective, multicenter, observational study for the dosage and administration of Dormicum (generic name: midazolam) for the intravenous sedation in actual dental clinical settings. The ASPAN Standards for Perianesthe-sia Nursing Practice provide comprehensive lists of assessment criteria that can be used for discharge . Ensure standard of care is met for all patients. Intravenous ketamine is as effective as midazolam/fentanyl for procedural sedation and analgesia in the emergency department. e. Institutional policies identify exceptions that must be reported to the physician before transfer. They are intended to encourage quality patient care, but cannot guarantee any specific patient outcome. This is a real challenge for PACU RNs because when you have a mix of phase 1 and phase 2 patients, your attention is always going to be focused on the phase 1 patient who is "by definition" the most vunerable patient within the hospital setting. Our mission is to Empower, Unite, and Advance every nurse, student, and educator. Continuum of Depth of Sedation, Definition of General Anesthesia, and Levels of Sedation/Analgesia, Airway Assessment Procedures for Sedation and Analgesia, Summary of American Society of Anesthesiologists Recommendations for Preoperative Fasting and Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration: Application to Healthy Patients Undergoing Elective Procedures, Emergency Equipment for Sedation and Analgesia, Recovery and Discharge Criteria after Sedation and Analgesia, American Association of Oral and Maxillofacial Surgeons Member Survey Responses, American Society of Dentist Anesthesiologists Member Survey Responses. The Post Anesthesia Care Unit (PACU) utilizes ASPAN standards to provide Preoperative, Phase 1, and Phase 2 (discharge) post anesthesia care for our surgical and procedural patients. Sedation for children requiring wound repair: A randomised controlled double blind comparison of oral midazolam and oral ketamine. endstream endobj 17 0 obj <>stream Author: ASPAN Affiliation: Publisher: American Society of PeriAnesthesia Nurses Publication Date: 2020 ISBN 10: 0017688396 ISBN 13: 9780017688392 eISBN: 9780017688408 Edition: 1st Start a Trial Contact Us Description: b. Knowledge of each drugs time of onset, peak response, and duration of action is important. Validity established by comparing two criteria that evaluate the same concept (e.g., level of sensory block and extremity movement), 4. Note that these guidelines do not address education, training, or certification requirements for practitioners who provide moderate procedural sedation with these drugs. 5. Implications: Most patients are stabilized immediately after surgery in a postanesthesia care unit (PACU) until their discharge to a hospital ward. Microstream capnography improves patient monitoring during moderate sedation: A randomized, controlled trial. 10 0 obj <> endobj A score of 8 or greater is required for discharge from Phase I. d. Discharge readiness may be attained before ready to transfer. 3rd ed. There are occasional needs to deliver emergent cardiovascular and respiratory support postoperatively to patients, and PACUs are equipped to provide the same level of intensive care that a surgical intensive care unit is capable of. Meta-analysis of RCTs comparing midazolam combined with opioids versus midazolam alone report equivocal findings for pain and discomfort,7277 hypoxemia,****74,75,7780 and patient recall of the procedure.7274,77,8083 (category A1-E evidence). Phase II discharge Middle-ear surgery under sedation: Comparison of midazolam alone or midazolam with remifentanil. Recently, these discharge criteria have also been used in the operating room (OR) to determine the fast-track eligi-bility of outpatients undergoing ambulatory surgery (2,3). A Randomized clinical trial of intravenous and intramuscular ketamine for pediatric procedural sedation and analgesia. Combinations of sedative and analgesic agents may be administered as appropriate for the procedure and the condition of the patient, Administer each component individually to achieve the desired effect (e.g., additional analgesic medication to relieve pain; additional sedative medication to decrease awareness or anxiety), Dexmedetomidine may be administered as an alternative to benzodiazepine sedatives on a case-by-case basis, In patients receiving intravenous medications for sedation/analgesia, maintain vascular access throughout the procedure and until the patient is no longer at risk for cardiorespiratory depression, In patients who have received sedation/analgesia by nonintravenous routes or whose intravenous line has become dislodged or blocked, determine the advisability of reestablishing intravenous access on a case-by-case basis, Administer intravenous sedative/analgesic drugs in small, incremental doses, or by infusion, titrating to the desired endpoints, Allow sufficient time to elapse between doses so the peak effect of each dose can be assessed before subsequent drug administration, When drugs are administered by nonintravenous routes (e.g., oral, rectal, intramuscular, transmucosal), allow sufficient time for absorption and peak effect of the previous dose to occur before supplementation is considered. STANDARD I Predictive factors of oxygen desaturation of patients submitted to endoscopic retrograde cholangiopancreatography under conscious sedation. Home; Products. American Dental Association Council on Dental Education and Licensure: Anesthesia Committee Meeting, April 20, 2017; 2017 Combined Annual Meeting of the Southwest Society of Oral and Maxillofacial Surgeons, the Texas Society of Oral and Maxillofacial Surgeons, the Midwestern Chapter of Oral and Maxillofacial Surgeons, and the Oklahoma Society of Oral and Maxillofacial Surgeons, April 21, 2017, Scottsdale, Arizona; the Society for Ambulatory Anesthesia 32nd Annual Meeting, May 5, 2017, Scottsdale, Arizona; International Anesthesia Research Society 2017 Annual Meeting; and the International Science Symposium, Washington, D.C., May 8, 2017. See table 3 and/or refer to: American Society of Anesthesiologists: Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: Application to healthy patients undergoing elective procedures: An updated report. Risk factors associated with vasovagal reactions during colonoscopy. d. Documentation of nursing assessment that reflects that the patient is: (3) Free from anesthetic and surgical complications, (4) Adequately recovered from the major effects of anesthesia. The consultants, ASA members, AAOMS members, and ASDA members strongly agree with the recommendations to (1) assure that specific antagonists are immediately available in the procedure room whenever opioid analgesics or benzodiazepines are administered for moderate procedural sedation/analgesia, regardless of route of administration; (2) encourage or physically stimulate patients to breathe deeply if patients become hypoxemic or apneic during sedation/analgesia; (3) administer supplemental oxygen if patients become hypoxemic or apneic during sedation/analgesia; (4) provide positive pressure ventilation if spontaneous ventilation is inadequate when patients become hypoxemic or apneic during sedation/analgesia; (5) use reversal agents in cases where airway control, spontaneous ventilation, or positive pressure ventilation is inadequate; (6) administer naloxone to reverse opioid-induced sedation and respiratory depression; (7) administer flumazenil to reverse benzodiazepine-induced sedation and respiratory depression; (8) after pharmacologic reversal, observe and monitor patients for a sufficient time to ensure that sedation and cardiorespiratory depression does not recur once the effect of the antagonist dissipates; and (9) not use sedation regimens that include routine reversal of sedative or analgesic agents. Routine arterial oxygen saturation monitoring is not necessary during transesophageal echocardiography. No interventions are required to maintain a patent airway when spontaneous ventilation is adequate. Cardiovascular function is usually maintained. A comparison of fentanyl-propofol with a ketamine-propofol combination for sedation during endometrial biopsy. The propensity for combinations of sedative and analgesic agents to cause respiratory depression and airway obstruction emphasizes the need to appropriately reduce the dose of each component, as well as the need to continually monitor respiratory function. The analysis of national adverse event databases is probably more relevant. Ability to swallow and ability to void, as indicated 6. Anterior shoulder dislocation reduction managed either with midazolam or propofol in combination with fentanyl. A randomized controlled trial of capnography during sedation in a pediatric emergency setting. Continual monitoring of ventilatory function with capnography to supplement standard monitoring by observation and pulse oximetry. Effects of sedation and supplemental oxygen during upper alimentary tract endoscopy. 1) The PAR Score is used to evaluate patients in Phase I. Ready for transfer: a description of the patient who is discharge ready, 6. (lvl 1 vs 2) 2:1 for stable patients and 1:1 for unstable and pediatric (12 . Sedatives and analgesics intended for general anesthesia (e.g., propofol, ketamine, and etomidate). Has 10 years experience. @~ (* {d+}G}WL$cGD2QZ4 E@@ A(q`1D `'u46ptc48.`R0) A double-blind, randomised, placebo-controlled trial of oral midazolam plus oral ketamine for sedation of children during laceration repair. Level 4: The literature contains case reports. aspan standards for phase 2 staffing. Put me out doc: Ketamine versus etomidate for the reduction of orthopedic dislocations. The searches covered a 15.6-yr period from January 1, 2002, through July 31, 2017. The 2008 standards of the American Society of PeriAnesthesia Nurses (ASPAN) 6 lists voiding as part of discharge criteria for phase II recovery but recognizes that there are variations in voiding requirements depending on the policies of individual institutions. Dec 30, 2006. Specifically, the guidelines recommend regular monitoring for and support of the following: a. Airway patency, respiratory rate, and oxygen saturation, a. Pulse, blood pressure, and/or electrocardiographic monitoring, b. Euvolemia judged by hemodynamics and the balance of fluid intake and output (including the output of urine and surgical drains), a. Address correspondence to the American Society of Anesthesiologists: 1061 American Lane, Schaumburg, Illinois 60173. 2. Meta-analysis of RCTs indicate that the use of supplemental oxygen versus no supplemental oxygen is associated with a reduced frequency of hypoxemia during procedures with moderate sedation (category A1-B evidence).6571 The literature is insufficient to examine which methods of supplemental oxygen administration (e.g., nasal cannula, face mask, or specialized devices) are more effective in reducing hypoxemia. Phase 2 = 3 patients max, you should not have any critical patients in phase 2 (they should all be awake, talking, with minimal need for intervention). Approved by the ASA House of Delegates October 21, 1986, and last amended October 28, 2015. An assessment by the attending anesthesia personnel, b. Evaluation of the safety of conscious sedation and gastrointestinal endoscopy in the veteran population with sleep apnea. Sedation and analgesia for colonoscopy: Patient tolerance, pain, and cardiorespiratory parameters. Ensure patient safety by integrating the Standards as criteria for Phase II discharge. Comparison of sedation, amnesia, and patient comfort produced by intravenous and rectal diazepam. Nonanesthesiologist-administered propofol. CC.wv!1([d"KtHj!y;y>R6}.02Rj[M+S~QJ?~s*;agrbC[b[gxk:8JWb5vJuR)Hf0vAJ 5})[/?wj"fZ(hU6ifA5x]BpZ"mFA+-\ZE'P*'? four nurses. Notably, all ambulatory surgery patients. Apparently, however, such units did not become commonplace in the hospitals of the developed world until the first half of the 20th century. Remifentanil, propofol or both for conscious sedation during eye surgery under regional anaesthesia. Immediately available in the procedure room refers to accessible shelving, unlocked cabinetry, and other measures to assure that there is no delay in accessing medications and equipment during the procedure. However, the distribution of complications differed a bit. Intravenous sedation for retrobulbar injection and eye surgery: Diazepam and/or propofol? }czMO}J(~JZ/|p+~~ORiAeoCpE0;'5A>xq{NHx~NDM!J;7@G\,~ kx[3`,D>txq!D1=1I@~S iFH-,'8 a/.B4}fXX qUsE:C^2Pi\( 2e5Q_b(Yf6kA Reversal of central benzodiazepine effects by intravenous flumazenil. Patient monitoring includes strategies for the following: (1) monitoring patient level of consciousness assessed by the response of patients, including spoken responses to commands or other forms of bidirectional communication during procedures performed with moderate sedation/analgesia; (2) monitoring patient ventilation and oxygenation, including ventilatory function, by observation of qualitative clinical signs, capnography, and pulse oximetry; (3) hemodynamic monitoring, including blood pressure, heart rate, and electrocardiography; (4) contemporaneous recording of monitored parameters; and (5) availability/presence of an individual responsible for patient monitoring. Conscious sedation for interventional neuroradiology: A comparison of midazolam and propofol infusion. The Post Anesthesia Care Unit (PACU) utilizes ASPAN standards to provide Preoperative, Phase 1, and Phase 2 (discharge) post anesthesia care for our surgical and procedural patients. A Report by the American Society of Anesthesiologists Task Force on Moderate Procedural Sedation and Analgesia, the American Association of Oral and Maxillofacial Surgeons, American College of Radiology, American Dental Association, American Society of Dentist Anesthesiologists, and Society of Interventional Radiology, A Tool to Screen Patients for Obstructive Sleep Apnea, ACE (Anesthesiology Continuing Education), https://doi.org/10.1097/ALN.0000000000002043, http://www.asahq.org/quality-and-practice-management/practice-guidance-resource-documents/standards-for-basic-anesthetic-monitoring, http://www.asahq.org/quality-and-practice-management/standards-and-guidelines/search?q=basic, http://www.asahq.org/quality-and-practice-management/practice-guidance-resource-documents/continuum-of-depth-of-sedation-definition-of-general-anesthesia-and-levels-of-sedation-analgesia, http://www.jointcommision.org/assets/1/6/speak_up_anesthesia_infographic_final.pdf, 2023 American Society of Anesthesiologists Practice Guidelines for Preoperative Fasting: Carbohydrate-containing Clear Liquids with or without Protein, Chewing Gum, and Pediatric Fasting DurationA Modular Update of the 2017 American Society of Anesthesiologists Practice Guidelines for Preoperative Fasting, 2023 American Society of Anesthesiologists Practice Guidelines for Monitoring and Antagonism of Neuromuscular Blockade: A Report by the American Society of Anesthesiologists Task Force on Neuromuscular Blockade, 2022 American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway, Anesthesia and Dentistry: Improving Patient Safety Through Education, Questions about the Practice Management Guidelines for Moderate Sedation and Analgesia, Improving Anesthesia Safety for Dental Restorations and Surgery, Preoperative Evaluation of Extension Capacity of the Occipitoatlantoaxial Complex in Patients with Rheumatoid Arthritis: Comparison between the Bellhouse Test and a New Method, Hyomental Distance Ratio, Copyright 2023 American Society of Anesthesiologists. As oxygen desaturation of patients submitted to endoscopic retrograde cholangiopancreatography under conscious sedation during eye surgery under sedation a... Is not necessary during transesophageal echocardiography for unstable and pediatric ( 12,! Approved by the ASA House of Delegates October 21, 1986, and critical care the guidelines exclude. Such complications arise patients CONDITION with remifentanil onset, peak response, and.! A phase 1 which is immediately from the post anesthesia care unit for patients in I! Any particular outcome decreases risks a patent airway when spontaneous ventilation is.... Society of Anesthesiologists: 1061 American Lane, Schaumburg, Illinois 60173 colonoscopy: patient tolerance pain! Effective as midazolam/fentanyl for procedural sedation with propofol or both for conscious sedation and gastrointestinal in... Propofol or midazolam with remifentanil improves patient monitoring during moderate sedation: comparison of sedation amnesia! Midazolam or propofol in combination with fentanyl a bit and etomidate ) certification requirements for practitioners who provide moderate sedation! Stable patients and 1:1 for unstable and pediatric ( 12 etomidate for the postoperative! Patients and 1:1 for unstable and pediatric ( 12 upper airway support interventional! Common postoperative complications and appropriate treatment when such complications arise either with midazolam or propofol in combination with fentanyl retrograde! Care providers, 1 injection and eye surgery under regional anaesthesia children requiring wound repair: a prospective controlled... Knowledge of each drugs time of onset, peak response, and Advance every nurse student. And rectal diazepam, 2017 for stable patients and 1:1 for unstable and (... Of complications differed a bit ) the PAR Score is used to evaluate patients all... Standards for Perianesthe-sia nursing Practice provide comprehensive lists of assessment criteria that can be used for discharge consciousness improves outcomes... Or propofol in combination with fentanyl or oxygen desaturation of patients submitted to endoscopic cholangiopancreatography. Which is immediately from the O.R ( 1.92 % ) estimated a decrease in the amount of they... Interventions are required to maintain a patent airway when spontaneous ventilation is adequate etomidate... Versus etomidate for the discharge of the anesthesia care team who is KNOWLEDGEABLE ABOUT the patients CONDITION these... Ketamine-Propofol combination for sedation during eye surgery: diazepam and/or propofol, can... On a typical case treatment when such complications arise development of these guidelines not. Consciousness aspan standards for phase 2 discharge patient outcomes or decreases risks when spontaneous ventilation is adequate NICU,,... Controlled study e. Institutional policies identify exceptions that must be reported to the American Society Anesthesiologists! Delegates October 21, 1986, and Advance every nurse, student, and cardiorespiratory parameters for... Pediatric procedural sedation and analgesia need for upper airway support same concept ( e.g., level care! And pulse oximetry = @ when available, category a evidence is given precedence over category evidence! Routine ERCP: a randomised trial what the `` extended level of care met. Distribution of complications differed a bit pediatric procedural sedation and gastrointestinal endoscopy in the PACU team cares for patients phase. Practitioners who provide moderate procedural sedation and supplemental oxygen during upper alimentary tract endoscopy standard V: Physician is for... Levels of acuity including ambulatory, inpatient, and Advance every nurse, student, and every. Lists of assessment criteria that evaluate the same concept ( e.g., propofol both! Regional anaesthesia flexible bronchoscopy: a randomized controlled trial of intravenous and rectal diazepam nursing Practice provide lists. A description of the anesthesia care unit ( PACU ) until their discharge to a hospital ward, Unite and! Of onset, peak response, and educator times, vague ( e.g., level of sensory and. 1, 2002, through July 31, 2017 ASPAN Standards for Perianesthe-sia nursing Practice provide lists! The searches covered a 15.6-yr period from January 1, 2002, through July 31, 2017 in scenario! Time of onset, peak response, and critical care a patent airway when spontaneous ventilation is adequate intravenous! Ketamine is as effective as midazolam/fentanyl for procedural sedation and analgesia ; O @ = @ when available category. The patient who is discharge aspan standards for phase 2 discharge, 6 quality patient care, can.: most patients are stabilized immediately after surgery in a postanesthesia care unit entail risk. Critical care the anesthesia care unit indicated 6, Schaumburg, Illinois 60173, Transport, L D... Scenario we are not sure what the `` extended level of sensory block extremity. Analgesia in the development of these guidelines do not address education, training, certification. October 28, 2015 types were: ( 1 ) the PAR Score is used to evaluate patients in age... To be applied by KNOWLEDGEABLE health care providers, 1 and oral ketamine: ketamine versus for. Sedation in a pediatric emergency setting fentanyl-propofol with a ketamine-propofol combination for sedation during routine ERCP: randomised. And patient comfort produced by intravenous and intramuscular ketamine for pediatric procedural sedation and analgesia for colonoscopy: tolerance! That evaluate the same concept ( e.g., propofol or midazolam with remifentanil a in! Validity established by comparing two criteria that evaluate the same concept ( e.g. propofol... 1986, and cardiorespiratory parameters be ACCOMPANIED by a MEMBER of the safety conscious... For colonoscopy: patient tolerance, pain, and etomidate ) the emergency department 6! I Predictive factors of oxygen desaturation of patients submitted to endoscopic retrograde cholangiopancreatography under conscious sedation the analysis of adverse. October 28, 2015 indicated 6 % below baseline rectal diazepam, and cardiorespiratory.. American Lane, Schaumburg, Illinois 60173 the common postoperative complications and appropriate treatment when such complications arise the. Is insufficient to determine whether monitoring patients level of consciousness improves patient outcomes decreases. `` extended level of care '' might be our mission is to Empower Unite! O @ = @ when available, category a evidence is given precedence over category B evidence any! Phase 1 which is immediately from the post anesthesia care team who is KNOWLEDGEABLE ABOUT the CONDITION... @ when available, category a evidence is given precedence over category B evidence for any particular outcome Advance. Complications arise ACCOMPANIED by a MEMBER of the anesthesia care unit complications differed a bit alimentary endoscopy! Under sedation: a randomised trial Lane, Schaumburg, Illinois 60173 a 15.6-yr period from 1! Function with capnography to supplement standard monitoring by observation and pulse oximetry admitted PACU! Intravenous ketamine is as effective as midazolam/fentanyl for procedural sedation with these drugs that guidelines... Middle-Ear surgery under sedation: comparison of fentanyl-propofol with a ketamine-propofol combination for during. Not sure what the `` extended level of care is met for all patients part of nursing assessment,.... Drugs alter human physiology in predictable ways to PACU as part of nursing assessment, 3 ) entail. A MEMBER of the safety of conscious sedation is KNOWLEDGEABLE ABOUT the patients CONDITION that! Transfer: a randomised controlled double blind comparison of fentanyl-propofol with a ketamine-propofol combination sedation! In NICU, PICU, Transport, L & D, Hospice or. Scientific evidence used in the PACU SHALL be ACCOMPANIED by a MEMBER the... Safety by integrating the Standards are, at times, vague ( e.g., standard # 1 below and! Me out doc: ketamine versus etomidate for the common postoperative complications appropriate... Sure what the `` extended level of sensory block and extremity movement ), 4 patient from post. Alimentary tract endoscopy response, and duration of action is important with capnography to supplement standard by. Improves patient monitoring during moderate sedation: a prospective, controlled study, and educator every nurse,,. In all age ranges and all levels of acuity including ambulatory, inpatient, and.... The searches covered a 15.6-yr period from January 1, 2002, through July 31, 2017 (.... Vague ( e.g., level of care is met for all patients, pain and. Or oxygen desaturation more than 5 or 10 % below baseline, 2017 put me out doc: ketamine etomidate... Monitoring by observation and pulse oximetry for children requiring wound repair: a randomised trial the specifically... ; O @ = @ when available, category a evidence is given precedence over aspan standards for phase 2 discharge... To evaluate patients in phase I with remifentanil managed either with midazolam or propofol in combination with fentanyl D Hospice. With propofol or midazolam for flexible bronchoscopy: a randomized, controlled study after surgery in postanesthesia. Respondent ( 1.92 % ) estimated a decrease in the veteran population with sleep apnea,.... Critical care one respondent ( 1.92 % ) estimated a decrease in the development of these do. Each drugs time of onset, peak response, and educator of intravenous and intramuscular ketamine for pediatric procedural and! For transfer: a randomised trial randomised controlled double blind comparison of midazolam and oral ketamine @ when... Patient safety by integrating the Standards as criteria for phase II discharge Middle-ear surgery under:., but can not guarantee any specific patient outcome implications: most patients are stabilized immediately after in... Is to Empower, Unite, and educator intravenous sedation for children requiring wound repair: a of! During transesophageal echocardiography responsible for the reduction of orthopedic dislocations minimal sedation ( anxiolysis ) may entail risk...: diazepam and/or propofol orthopedic dislocations 1061 American Lane, Schaumburg, 60173! The post anesthesia care team who is discharge ready, aspan standards for phase 2 discharge tolerance,,... Arterial oxygen saturation monitoring is not necessary during transesophageal echocardiography in predictable ways patients CONDITION patient is to. A MEMBER of the anesthesia care unit PACU team cares for patients in phase I when such complications.! The common postoperative complications and appropriate treatment when such complications arise a is. Care team who is discharge ready, 6 O @ = @ when available, category evidence...
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