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Sedation: it is better to be safe than sorry.
| Content Provider | Semantic Scholar |
|---|---|
| Author | Kakazu, Clinton Z. Lippmann, Maurice |
| Copyright Year | 2014 |
| Abstract | Editor—We recently came across an editorial in the British Journal of Anaesthesia entitled 'Is sedation by non-anaesthetists really safe?' written by Drs Webb and Hunter. 1 This topic is becoming more and more at the forefront in our speciality. After spending many years as an anaesthesiologist and taking care (hands on) of patients, including neonates and patients up to 106 yr old, using all types of anaesthetic techniques and agents, we personally cannot understand why any patient would want or allow a non-anaesthesiologist to anaes-thetize them. The authors 1 of the editorial attempt to point out the pros and cons of the situations and to a great extent, we agree with them, but the fact remains an anaesthesiologist should be the one sedating patients, not someone else. Gastro-enterologists love to use propofol when they perform their en-doscopies, but when the patients get into trouble, cannot ventilate or oxygenate because the level of sedation is too deep, cannot follow commands, become hypotensive and apnoeic, who does the gastroenterologist ultimately call? An anaesthesiologist. Conscious sedation is a tricky technique because the person administering the sedative is actually walking a 'fine line'. The agent propofol is the drug most widely used and it is very easy to place a patient into a 'deep' sedation level, because of its narrow therapeutic index. A non-anaesthesiologist is less likely to recognize the varying levels of sedation and what to watch out for at each level. Moreover, if the patient stops breathing and needs to be rescued with tracheal intubation, does a non-anaesthesiologist know how to proceed? In fact, the propofol package insert states.. . 'to be administered by those trained in general anesthesia'. Because propofol is the drug most physicians use for sedation during endoscopies, cardioversions, cardiac electrophysiology procedures, these patients must be monitored with EKGs, arterial pressure, pulse oximetry, and capnography. Non-anaesthesiologists may conveniently omit the use of these monitors. Hospitals and administration always look at the cost to them, but overlook the safety of the patient. The controversy on whether or not a non-anaesthesiologist can administer propofol for sedation for various procedures is progressing even further. A more recent article published in the BJA October issue 2013 2 suggests emergency room physicians to administer propofol as one i.v. bolus (1 mg kg 21) to their patients and supplement when necessary. The authors 2 of the article concluded that propofol was safe in their series … |
| Starting Page | 586 |
| Ending Page | 586 |
| Page Count | 1 |
| File Format | PDF HTM / HTML |
| DOI | 10.1093/bja/aeu037 |
| PubMed reference number | 24535520 |
| Journal | Medline |
| Volume Number | 112 |
| Issue Number | 3 |
| Alternate Webpage(s) | https://oup.silverchair-cdn.com/oup/backfile/Content_public/Journal/bja/112/3/10.1093/bja/aeu037/2/aeu037.pdf?Expires=1492416577&Key-Pair-Id=APKAIUCZBIA4LVPAVW3Q&Signature=eoBF605P6B-d03HtmlOuBPGu8s0DQuLX-zLPsXePiydmi9iBMR4EgGb0USoXjsEd5waxOLsCCGB6lPAH6vg9hmi9Pj49QHKj6aINVs8rn9lVqiVRZrE2leLTqVeEvnutIQuDC3IN1kHADmm~yPdWx0mhUj5fCr~v2bc-YwkoZdpGh5iZyZuJVM9TTtMWo8F2dA4wJ7mWxBftN-9z1dRwSUbPW9y-N2Q67qgY9vawMyl77UvTddZgxeGBCtqU3mnEKcn~ZTh1G3gkOCMSKCxYQAxw-G1kPOwItZbH~55WbJwpdgHskcUZAUBgBGOczfwQx7APFs6vnSwe6UYwMuJgiw__ |
| Alternate Webpage(s) | https://doi.org/10.1093/bja%2Faeu037 |
| Journal | British journal of anaesthesia |
| Language | English |
| Access Restriction | Open |
| Content Type | Text |
| Resource Type | Article |
