Medicine Moderate Sedation Exam
/. Moderate Sedation Defined: - Answer-✅administration of any medication with
sedative/hypnotic properties capable of altering the state of consciousness and/or
compromising protective reflexes
/.AMA Office-based Surgery
Core Principle #10 - Answer-✅Physicians
administering or supervising moderate
sedation/analgesia, deep
sedation/analgesia, or general anesthesia
should have appropriate education and
training.
/.Training of personnel - Answer-✅Individuals responsible for patients
sedation/analgesia should understand the pharmacology of the agents that are
administered and the role of pharmacologic antagonists...
They should be able to recognize complications and at least one caregiver should be
capable of establishing a patent airway and positive pressure ventilation
/.Availability of an individual responsible for patient monitoring - Answer-✅A designated
individual, *other than the practitioner performing the procedure*, should be present to
monitor the patient throughout procedures performed with sedation/analgesia...during
moderate sedation, this individual may assist with minor, interruptible tasks once the
patient's level of sedation/analgesia and vital signs have stabilized
need at least 3 people in room for sx
/.Monitoring Guidelines - Answer-✅Level of consciousness
Pulmonary ventilation
Oxygenation
emodynamics
/.Use of supplemental oxygen - Answer-✅Equipment to administer supplemental
oxygen should be present when sedation/analgesia is administered
/.Anesthetic induction agents used for sedation/analgesia (propofol, methohexital,
ketamine): - Answer-✅The literature suggests that when administered by non-
, anesthesiologists, propofol and ketamine can provide satisfactory moderate sedation;
however, consultants agree that AVOIDING these medications decreases the likelihood
of adverse outcomes during moderate sedation.
/.Key Elements of JCAHO's Agenda for Moderate Sedation: - Answer-✅Moderate
sedation has been identified as a high risk, high volume, problem prone care process.
A "single and consistent policy" for the use of moderate sedation across all sites of care.
Based on minimum standards established by anesthesiology.
/.Goals Of Moderate Sedation - Answer-✅Patient responds to tactile stimulation
Maintains a patent airway
Maintains protective reflexes
Maintains cardiovascular homeostasis
/.Moderate sedation - Answer-✅purposeful response to command or tactile stimulation
/.deep sedation - Answer-✅not easily aroused, may have purposeful response to strong
stimulation, risk of ventilation/airway, and CV compromise
/.American Society of Anesthesiologists (ASA) classification of patient condition: -
Answer-✅I Normal, healthy
II Mild systemic disease - no limitation in daily activity
III Significant systemic disease - limits daily activity
IV Life threatening systemic disease
V Pre-morbid condition
VI Organ harvest
/.Areas of special emphasis for Evaluation,
Assessment, and Anesthetic plan: - Answer-✅Airway
Respiratory system
Cardiovascular system
Systems with the smallest margin for compromise
Profoundly affected by moderate sedation medications
Imply changes in usual approach (possible Anesthesia
consult)
/.Airway Assessment, Physical Exam - Answer-✅Habitus: significant obesity (esp. of
neck & face)
Head & Neck: short neck, limited neck extension, decreased hyoid-mental distance
(<3cm in an adult), neck mass, cervical spine disease or trauma, tracheal deviation,
dysmorphic facial features (e.g., Pierre-Robin Syndrome)
/. Moderate Sedation Defined: - Answer-✅administration of any medication with
sedative/hypnotic properties capable of altering the state of consciousness and/or
compromising protective reflexes
/.AMA Office-based Surgery
Core Principle #10 - Answer-✅Physicians
administering or supervising moderate
sedation/analgesia, deep
sedation/analgesia, or general anesthesia
should have appropriate education and
training.
/.Training of personnel - Answer-✅Individuals responsible for patients
sedation/analgesia should understand the pharmacology of the agents that are
administered and the role of pharmacologic antagonists...
They should be able to recognize complications and at least one caregiver should be
capable of establishing a patent airway and positive pressure ventilation
/.Availability of an individual responsible for patient monitoring - Answer-✅A designated
individual, *other than the practitioner performing the procedure*, should be present to
monitor the patient throughout procedures performed with sedation/analgesia...during
moderate sedation, this individual may assist with minor, interruptible tasks once the
patient's level of sedation/analgesia and vital signs have stabilized
need at least 3 people in room for sx
/.Monitoring Guidelines - Answer-✅Level of consciousness
Pulmonary ventilation
Oxygenation
emodynamics
/.Use of supplemental oxygen - Answer-✅Equipment to administer supplemental
oxygen should be present when sedation/analgesia is administered
/.Anesthetic induction agents used for sedation/analgesia (propofol, methohexital,
ketamine): - Answer-✅The literature suggests that when administered by non-
, anesthesiologists, propofol and ketamine can provide satisfactory moderate sedation;
however, consultants agree that AVOIDING these medications decreases the likelihood
of adverse outcomes during moderate sedation.
/.Key Elements of JCAHO's Agenda for Moderate Sedation: - Answer-✅Moderate
sedation has been identified as a high risk, high volume, problem prone care process.
A "single and consistent policy" for the use of moderate sedation across all sites of care.
Based on minimum standards established by anesthesiology.
/.Goals Of Moderate Sedation - Answer-✅Patient responds to tactile stimulation
Maintains a patent airway
Maintains protective reflexes
Maintains cardiovascular homeostasis
/.Moderate sedation - Answer-✅purposeful response to command or tactile stimulation
/.deep sedation - Answer-✅not easily aroused, may have purposeful response to strong
stimulation, risk of ventilation/airway, and CV compromise
/.American Society of Anesthesiologists (ASA) classification of patient condition: -
Answer-✅I Normal, healthy
II Mild systemic disease - no limitation in daily activity
III Significant systemic disease - limits daily activity
IV Life threatening systemic disease
V Pre-morbid condition
VI Organ harvest
/.Areas of special emphasis for Evaluation,
Assessment, and Anesthetic plan: - Answer-✅Airway
Respiratory system
Cardiovascular system
Systems with the smallest margin for compromise
Profoundly affected by moderate sedation medications
Imply changes in usual approach (possible Anesthesia
consult)
/.Airway Assessment, Physical Exam - Answer-✅Habitus: significant obesity (esp. of
neck & face)
Head & Neck: short neck, limited neck extension, decreased hyoid-mental distance
(<3cm in an adult), neck mass, cervical spine disease or trauma, tracheal deviation,
dysmorphic facial features (e.g., Pierre-Robin Syndrome)
