DOI: https://doi.org/10.22141/2224-0586.8.95.2018.155151

An overview of clinical practice guidelines for outpatient sedation

V.I. Cherniy, K.A. Kolhanova, V.A. Paykush, I.V. Vasylieva

Abstract


This article presents the basic concepts and principles of outpatient anesthesia in adults and children (MedLine, EMBASE, PubMed). Administration of local anesthesia, sedation and general anesthesia is an important part of outpatient clinical practice. Conscious sedation and pain control can be defined as the application of different chemical agents for the prevention and effective treatment of perioperative anxiety and pain. Procedural sedation is a drug-induced depression of consciousness during which patients respond to verbal commands alone or accompanied by tactile stimulation. No interventions are required to maintain a patent’s airway, and spontaneous ventilation is adequate, as well as cardiovascular function. For anesthesiologists, who use in-office sedation, it is important that they have education, experience and skills for safely administer conscious sedation. Moreover, practitioners and their assistants need regular training in basic life support and advanced live support in adults and children. Consequently, Standards for Basic Anesthetic Monitoring are intended to encourage quality patient care. They use for all case of procedural sedation, general anesthetics, regional anesthetics and monitored anesthesia care. There are many techniques for outpatient sedation, such as inhalation, oral, intranasal, intravenous administration of sedatives. However, the lingering effects of orally administered sedation medications can lead to prolonged sleep, irritability, and vomiting in children after they have been discharged from the dental clinic. Total intravenous anesthesia (TIVA) is a technique of general anesthesia, which uses a combination of agents given exclusively by the intravenous route without the use of inhalation agents. The inherent benefits of TIVA via a Target Controlled Infusion make it a more manageable technique for the patient’s care, while guarantees a faster and more comfortable patient recovery. The Bispectral Index (BIS) provides additional information for standard monitoring techniques that helps guide the administration of sedative-hypnotic agents. In results, the use of the BIS monitor helps to correct the level of office sedation so that less drugs are used to maintain the target level. The decision to discharge a patient undergoing outpatient sedation is an important part of the treatment. It must be achieved by an anesthesiologist and a surgeon without decrease of care quality. Therefore, the use of an objective assessment for the management of a fair and safe discharge is essential. The Post Anaesthetic Discharge Scoring System has proved to be an usefull scale that provides safe and comfortable discharge of patients.

Keywords


review; outpatient anesthesiology; procedural sedation

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