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Intravenous anaesthetic agents such as propofol must only be used by asecond medical practitioner trained in their use because of the risk ofunintentional loss of consciousness. These agents must not be administeredby the proceduralist.10. DOCUMENTATIONThe clinical record should include the names of staff performing sedation and/oranalgesia, with documentation of the history, examination and investigationfindings. A written record of the dosages of drugs and the timing of theiradministration must be kept as a part of the patient's records. Such entries shouldbe made as near the time of administration of the drugs as possible. This recordshould also note the regular readings from the monitored variables, includingthose in the recovery phase, and should contain other information as indicated inthe College Professional Document PS6 Recommendations on the Recording ofan Episode of Anaesthesia Care.11. RECOVERY AND DISCHARGE11.1 Recovery should take place under appropriate supervision in a properlyequipped and staffed area (see College Professional Document PS4Recommendations for the Post-Anaesthesia Recovery Room).11.2 Adequate staffing and facilities must be available in the recovery area formanaging patients who have become unconscious or who have sufferedcomplications during the procedure.11.3 Discharge of the patient should be authorised by the practitioner whoadministered the drugs, or another appropriately qualified practitioner. Thepatient should be discharged into the care of a responsible adult to whomwritten instructions should be given, including advice about eating anddrinking, pain relief, and resumption of normal activities, as well as aboutmaking legally-binding decisions, driving, or operating machinery.11.4 A system should be in place to enable safe transfer of the patient toappropriate medical care should the need arise.12. TRAINING IN PROCEDURAL SEDATION AND/OR ANALGESIA FORNON-ANAESTHETIST MEDICAL PRACTITIONERSIt is recommended that non-anaesthetist medical practitioners wishing to provideprocedural sedation/analgesia should have received a minimum of 3 months fulltime equivalent supervised training in procedural sedation and/or analgesia andanaesthesia. They should participate in a process of In-Training and CompetencyAssessment. Training should include completion of a crisis resourcemanagement simulation centre course.It is recognised that there will be non-anaesthetist medical practitioners whohave had many years experience in procedural sedation and/or analgesia, butwho may not have had a period of formal supervised training as described. Such7
longstanding clinical experience may be deemed equivalent to a formal period oftraining as described.Credentialling, training and clinical support of such medical practitioners shouldreceive close cooperation from nominated anaesthetists in the hospital or centre.Annual certification in advanced cardiac and life support, and evidence ofrelevant Continuing Professional Development, are required for credentialling.13. REFERENCESThe following references provide evidence to support the recommendations madein this document.AGA Institute (Cohen LB et al.). AGA Institute review of endoscopic sedation.Gastroenterology 2007; 133: 675-701American College of Radiology (Towbin et al.). ACR practice guideline for adultsedation/analgesia. 2005American Society of Anesthesiologists Task Force on Sedation and Analgesia by Non-Anesthesiologists (Gross JB et al.). Practice guidelines for sedation and analgesia bynon-anesthesiologists. Anesthesiology 2002; 96: 1004-1017American Society of Anesthesiologists. Statement on granting privileges foradministration of moderate sedation to practitioners who are non anaesthesiaprofessionals. 2006American Society for Gastrointestinal Endoscopy (Chutkan R et al.). Trainingguideline for use of propofol in gastrointestinal endoscopy. Gastrointestinal Endoscopy2004; 60: 167-172American Society for Gastrointestinal Endoscopy (Vargo JJ et al.). Training in patientmonitoring and sedation and analgesia. Gastrointestinal Endoscopy 2007; 66: 7-10Clarke AC, Chiragakis L, Hillman LC, Kaye GL. Sedation for endoscopy: the safe useof propofol by general practitioner sedationists. Medical Journal of Australia 2002;176: 159-162Faigel DO, Pike IM, et al. Quality indicators for gastrointestinal endoscopicprocedures: an introduction. Gastrointestinal Endoscopy 2006; 63 (4 Suppl.): S3-S9Qadeer MA, Vargo JJ, Khandwala F, Lopez R, Zuccaro G. Propofol versus traditionalsedative agents for gastrointestinal endoscopy: a meta-analysis. ClinicalGastroenterology & Hepatology 2005; 3: 1049-1056Rex DK Review article: moderate sedation for endoscopy: sedation regimens for nonanaesthesiologists.Alimentary Pharmacology & Therapeutics 2006; 24: 163-1718
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Anaesthesia Clinical Indicator User
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INDICATOR AREA 1: PRE-ANAESTHESIA P
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INDICATOR AREA 1: PRE-ANAESTHESIA P
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Page 58 and 59: AUSTRALIAN AND NEW ZEALAND COLLEGE
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Page 66 and 67: All College Professional Documents
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Page 76 and 77: 4.2.1 means for manual ventilation
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