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AUSTRALIAN AND NEW ZEALAND COLLEGE OFANAESTHETISTSABN 82 055 042 852Review PS9 (2008)GASTROENTEROLOGICAL SOCIETY OF AUSTRALIAABN 44 001 171 115ROYAL AUSTRALASIAN COLLEGE OF SURGEONSABN 29 004 167 766Guidelines on Sedation and/or Analgesia for Diagnostic andInterventional Medical or Surgical ProceduresThis document is intended to apply wherever procedural sedation and/or analgesiafor diagnostic and interventional medical and surgical procedures are administered,especially where sedation and/or analgesia may lead to general anaesthesia. TheAustralian and New Zealand College of Anaesthetists recognises that practitionerswith diverse qualifications and training are administering a variety of medications topatients to allow such procedures to be performed. This document addresses pertinentissues for all practitioners involved in such activities.1. DEFINITIONS1.1 Procedural sedation and/or analgesia implies that the patient is in a state ofdrug-induced permissiveness of uncomfortable or painful diagnostic orinterventional medical or surgical procedures. Lack of memory of distressingevents and/or analgesia are desired outcomes, but lack of response to painfulstimulation is not assured.1.1.1 Conscious Sedation is defined as a drug-induced depression ofconsciousness during which patients are able to respond purposefully toverbal commands or light tactile stimulation. No interventions are usuallyrequired to maintain a patent airway, spontaneous ventilation orcardiovascular function. Conscious sedation may be achieved by a widevariety of techniques including propofol, and may accompany localanaesthesia. All conscious sedation techniques should provide a margin ofsafety that is wide enough to render loss of consciousness unlikely.1.1.2 Deep levels of sedation, where consciousness is lost and patients onlyrespond to painful stimulation, are associated with loss of the ability tomaintain a patent airway, inadequate spontaneous ventilation and/orimpaired cardiovascular function. Deep levels of sedation may have similarrisks to general anaesthesia, and may require an equivalent level of care.1.1.3 Analgesia is reduction or elimination of pain perception, usually induced bydrugs which act locally (by interfering with nerve conduction) or generally(by depressing pain perception in the central nervous system).1
1.2 General Anaesthesia is a drug-induced state characterised by absence ofresponse to any stimulus, loss of protective airway reflexes, depression ofrespiration and disturbance of circulatory reflexes. General anaesthesia issometimes indicated during diagnostic or interventional medical or surgicalprocedures and requires the exclusive attention of an anaesthetist (see CollegeProfessional Document T1 – Recommendations on Minimum Facilities for SafeAdministration of Anaesthesia in Operating Suites and Other AnaesthetisingLocations)..2. AIMS AND RISKS OF PROCEDURAL SEDATION AND/OR ANALGESIAThe aims of procedural sedation and/or analgesia are to ensure patient safety andcomfort, and to facilitate completion of the planned procedure. In order to achievethese aims, a range of sedation options may be required during any one procedure,with a continuum from no medication, through conscious sedation and deepsedation, to general anaesthesia. While no sedation or conscious sedation withsmall doses of drugs such as benzodiazepines and opioids are options for somepatients and proceduralists, many patients and proceduralists want deep levels ofsedation or general anaesthesia to be an option during each procedure.Practitioners authorised or credentialled to administer procedural sedation and/oranalgesia should be aware that the transition from complete consciousnessthrough the various depths of sedation to general anaesthesia is a continuum andnot a set of discrete, well-defined stages. The margin of safety of drugs used toachieve sedation and/or analgesia varies widely between patients and loss ofconsciousness with its attendant risk of loss of protective reflexes may occurrapidly and unexpectedly. Therefore practitioners who administer sedative oranalgesic drugs that alter the conscious state of a patient must be prepared tomanage the following potential risks:2.1 Depression of protective airway reflexes and loss of airway patency.2.2 Depression of respiration.2.3 Depression of the cardiovascular system.2.4 Drug interactions or adverse reactions, including anaphylaxis.2.5 Individual variations in response to the drugs used, particularly in children,the elderly, and those with pre-existing medical disease.2.6 The possibility of deeper sedation or anaesthesia being used to compensatefor inadequate analgesia or local anaesthesia.2.7 Risks inherent in the wide variety of procedures performed under proceduralsedation and/or analgesia.2
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Anaesthesia Clinical Indicator User
Page 9 and 10: INDICATOR AREA 1: PRE-ANAESTHESIA P
Page 12 and 13: INDICATOR AREA 1: PRE-ANAESTHESIA P
Page 14 and 15: INDICATOR AREA 2: INTRA-OPERATIVE P
Page 16 and 17: Anaesthesia Clinical Indicators Ver
Page 18 and 19: INDICATOR AREA 4: POST-OPERATIVE PE
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Page 23 and 24: Area: 1 Pre-anaesthesia PeriodAnaes
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Page 27 and 28: Area: 2 Intra-operative PeriodAnaes
Page 29 and 30: Area: 3 Patient Recovery PeriodAnae
Page 31 and 32: Area: 4 Post-operative PeriodAnaest
Page 33 and 34: Area: 6 Obstetric Anaesthesia CareA
Page 39 and 40: CI 3.1CI 3.2CI 3.3CI 3.4CI 3.5requi
Page 41 and 42: CI 6.1CI 6.2CI 6.3Minimisation of p
Page 43 and 44: 2.1 The process involved in deliver
Page 45 and 46: REFERENCESSafety of Anaesthesia in
Page 52 and 53: Review PS8 (2008)AUSTRALIAN AND NEW
Page 54 and 55: 3.2.3 Supervised practical experien
Page 56 and 57: (d) Invasive Techniquesincluding in
Page 60 and 61: 2.8 Unexpected extreme sensitivity
Page 62 and 63: 5.7 If an appropriately trained med
Page 64 and 65: Intravenous anaesthetic agents such
Page 66 and 67: All College Professional Documents
Page 68 and 69: APPENDIX IIIPersonnel for Procedura
Page 74 and 75: Review PS4 (2006)AUSTRALIAN AND NEW
Page 76 and 77: 4.2.1 means for manual ventilation
Page 78 and 79: 6.7.3 specify the type of apparatus
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