What's considered sedation?

[Julie186]

Hey All, I'm looking to hear what is considered conscious sedation. I currently work in IR and our definition is a combination of a sedative and narcotic. Another hospital within my health system, however, frequently uses a "cocktail" of these medications and only consider the use of Versed with a narcotic to be sedation.

There is also some questions about how much narcotic can be used before the patient has to be set up/documented as sedated. For example, one of our docs says he read somewhere that 100 mcg of Fentanyl or more is sedating, but I find no evidence of this.

Looking for some input from the community:)

[dianah, ASN]

Is the purpose of the cocktail to sedate the patient? Or to treat pain and sedate?

If it is administered for sedation, it may need to be included under the Moderate Sedation umbrella, thus subject to monitoring.

Do some digging on the internet, for a large picture of the animal that is "moderate sedation." :)

At the simplest, it is medications (benzos and narcotics) given by qualified nurses (directed by MDs) to allay fears and relieve pain, often during or for procedures.

It should not be given according to whims ("I read somewhere that was OK to give") or anecdotal information but each facility should have in place Guidelines and Protocols for non-anesthesia personnel administering moderate sedation.

Those who will be administering medications must have demonstrated prowess in knowledge and skills necessary: pre-procedure assessment, medication dosages and reversal agents, how to prevent airway or other trouble (e.g., hypotension, oversedation, etc) and how to treat when recognized, how long and how often patient is to be monitored pre-, during- and post-procedure.

Here is a helpful article from the American Association of Nurse Anesthetists, http://www.aana.com/resources2/professionalpractice/Documents/PPM%20Consid%204.2%20RNs%20Engaged%20in%20Sedation%20Analgesia.pdf

Will be interested to see others' comments about this. :)

[Radnurse54]

Sedation standards and policies in my experience are administered by the anesthesiology department. This is the first place you should start. Also, I am suprised that your department doesnt have a protocol that covers anxiolytics, moderate and deep sedation. Did you not have to take an exam at the hospital where you are to show your competency in sedation? Some big red flags are here for me. Start with anesthesia, they are your best resources.

[BexnRN]

Oh boy...you need to obtain a copy of your facility's policy and procedure regarding this. PRONTO. Versed and fentanyl are the first drugs of choice where I work. Even 25 mcg of fentanyl is sedation for us and we place the pt on a monitor with a nurse and chart it as such.

[Radnurse54]

We use versed and fentanyl as well the dosing of course is dependant on the procedure and patient. Protocol for sedation always requires monitoring of bp, pulse, resp and p02, in some area end tidal is also used as in MRI sedations.

There are several levels of sedation with accompanying criteria, this is a standard anesthesia scale. You should be able to find it on the national website for anesthesia.

[classicdame, MSN, EdD]

It is not the type of medication that defines sedation, it is the EFFECT it has on the patient. There is an excellent publication available free online. Practice Guidelines for Sedation and Analgesia by Non-Anesthesiologists" Anes 2002. 96:1004-17. American Society of Anesthesiologists. We use this a guide to determine our facility policies regardinng sedation. Better check the Nurse Practice Act and any Health and Occupations Codes for your state that relate to this topic. Heaven forbid that the wrong person was involved in a procedure from which the patient died and it was later determined that person should not have even been present, or given that medication, or whatever. Too risky for everyone involved. Remember, the MD caring for Michael Jackson was accused of murder.