Practice Guidelines for Moderate Procedural Sedation and Analgesia

The Practice Guidelines for Moderate Procedural Sedation are meant to help you choose which sedation level to use during surgical procedures. Before administering any sedation, you should evaluate your patient’s physical status and medical history. In addition, you should do a focused physical examination of the patient’s airway. You should also review your patient’s current medications and allergies.

The AORN has recently published updated guidelines for moderate sedation and analgesia. The guidelines emphasize the importance of proper patient assessment, monitoring, and competency. The policy also includes patient care scenarios that outline specific concerns regarding moderate sedation.

In California, hospitals that restrict procedural sedation deny their patient’s optimal comfort. In addition, these restrictions force emergency physicians to use less safe and effective sedative agents. A formal appraisal of the current limitations of procedural sedation in California hospitals would help emergency physicians make informed decisions and improve patient care quality.

The CMS’s policy also misclassifies the concept of sedation into two categories: anesthesia and analgesia. This confusion can lead to unsafe sedation. It’s also essential to distinguish between procedural sedation and analgesia. While analgesia and anesthesia are related, they have very different functions. ED physicians must manage the sedation continuum and be mindful of these differences to prevent unnecessary risks.

Moderate Procedural Sedation in hospitals should be administered only by a trained clinician. This technique is safe, but a skilled clinician must be available to treat adverse events. They must be able to assess patients’ airways and evaluate their risk factors. They should also understand the techniques and equipment used during the procedure and know the risks.

The CMS’s Practice Guidelines for Moderate ProceduralSedation are designed to help ensure the highest quality care for patients undergoing moderate sedation. This practice should be multidisciplinary and involve the broadest range of professionals. An interdisciplinary committee should also be used to develop solutions for these challenges.

A growing body of literature details the safe use of moderate sedation in children and adolescents. This body of literature also includes guidelines from the American Academy of Pediatrics and the Paediatric Sedation Research Consortium. These guidelines should help clinicians safely sedate children undergoing diagnostic or therapeutic procedures.

Although PSA is a core competency in emergency medicine, the guidelines for PSA vary from hospital to hospital. Hospital-based committees develop guidelines for PSA in the ED based on standards from medical societies. For example, ED PSA does not require preprocedural fasting. Furthermore, ETCO2 monitoring is not standard of care and should be based on local guidelines.


Published by

Dr. Carlos Chacon

As a board certified plastic surgeon, Dr. Carlos Chacon brings with him years of experience in the full spectrum of cosmetic surgery procedures. A fellowship at Keck School of Medicine at the University of Southern California equipped him with additional skills and knowledge to perform plastic surgery on patients who have lost a significant amount of weight as seen on ABC's hit primetime show, Extreme Makeover: Weight Loss Edition. On this show, overweight participants are tasked with losing half of their body weight through strategic dieting and exercise under the guidance and watchful eye of a trainer. Once the participant lost the necessary amount of weight, many elected to undergo plastic surgery to complete their Extreme Makeover. The surgical procedures included medically necessary and dramatic skin removal surgery.

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