Moderate Sedasi Di OK

PATIENT
SAFETY
FIRST
Moderate Sedation: A Primer for

Perioperative Nurses
JULIA METZNER, MD; KAREN B. DOMINO, MD, MPH
E conomic pressures require health care to be more

cost-effective and efficient than in the past. As a
result, procedures performed both inside and
outside of the OR increasingly use moderate sedation (previ-
ously known as conscious sedation). Although anesthesiologists
procedures. Nurses should understand that sedation is a
“continuum” of consciousness (Figure 1), and the nurse
providing sedation should be able to recognize whether the
next stage of sedation is developing and be ready to respond
appropriately.
and certified registered nurse anesthetists (CRNAs) possess the
highest degree of training and expertise in providing sedation,
Minimal Sedation
RNs can safely administer moderate sedation if they possess a
Minimal sedation is the administration of medication to
knowledge of the pharmacology, how sedation affects coexis-
reduce anxiety (ie, anxiolysis). This level of sedation allows the
tent conditions, monitoring and regulatory requirements, and
patient to respond normally to verbal commands and to
facility policies related to the administration of sedation. The
maintain normal airway reflexes and respiration. Minimal
American Society of Anesthesiologists (ASA),1 AORN,2 and
sedation has little effect on blood pressure or heart rate.
regulatory bodies such as The Joint Commission3 have
developed practice guidelines in efforts to unify and
standardize sedation practices across institutions. Moderate Sedation
Moderate sedation depresses the patient’s level of conscious-
TERMINOLOGY AND MEANING ness; however, the patient still is able to respond to verbal
Three levels of sedation (ie, minimal, moderate, deep) can be commands, either spontaneously or when accompanied by
provided to patients undergoing operative or other invasive light tactile stimulation. Spontaneous respiration is usually
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November 2015, Vol. 102, No. 5 Moderate Sedation: A Primer
Figure 1. The continuum of sedation.
adequate, and the patient can usually maintain a patent status 4 and 5), advanced age, young age (ie, younger than
airway. Cardiovascular function is usually maintained. five years), a long or complex procedure, or a procedure
that requires the prone position. Other factors include
Deep Sedation morbid obesity, sleep apnea, the potential for a difficult
Deep sedation results in significant depression of conscious- airway, a substance use disorder, a history of difficult
ness during which patients cannot be easily aroused; however, sedation, a prior adverse reaction to sedation/anesthesia,
they may respond purposefully following repeated or painful and chronic pain on opioid therapy.
stimulation. Patients may require help to maintain a patent
airway and their spontaneous ventilation may be inadequate. Fasting Guidelines
Cardiovascular function is usually adequate. In general, the The ASA guidelines recommend that patients do not ingest
ASA recommends and many hospital policies require the solid foods for six to eight hours before surgery and take only
presence of an anesthesia professional if deep sedation is clear liquids until two to three hours before the procedure
planned.1 Regardless of the sedation provider, deep sedation (Table 3). Longer fasting times may be necessary for pregnant
requires the immediate availability of an individual trained women, severely obese patients (body mass index [BMI] > 40
in cardiopulmonary resuscitation. kg/m2), and those with gastric paresis or gastroesophageal
reflux, diabetes mellitus, or other medical conditions that
PATIENT PREPARATION AND delay gastric emptying. Although not proven, antiemetic
SELECTION administration (eg, metoclopramide, histamine 2 blockers)
In 2005, the ASA created guidelines for granting privileges to may be useful in decreasing the risk for aspirating
nurses and nonanesthesiologist physicians to provide moderate gastric contents.
sedation.4 These guidelines (Table 1) target training in the
administration of sedative or analgesic medications, airway NECESSARY EQUIPMENT AND SUPPLIES
and resuscitation skills, patient evaluation, monitoring and Sedation and analgesia can result in adverse events including
interpreting physiological variables, postprocedure transport oversedation, respiratory depression, or cardiopulmonary ar-
and evaluation, and discharge criteria. rest. Therefore, it is mandatory for the surgical team to have
the appropriate emergency equipment near the sedation area.
Table 2 illustrates the preoperative patient factors that Supportive equipment must include
should prompt the nurse to ask for a consultation with an
anesthesia professional to evaluate the safety and provision oxygen;
of sedation. These factors include a serious illness (ie, ASA suction;
www.aornjournal.org AORN Journal j 527

MetznerdDomino November 2015, Vol. 102, No. 5
Table 1. Training and Credentialing in Moderate Table 1. (continued )

1
(conscious) Sedation for Registered Nurses
Competency
Category Required Skills and Knowledge
Competency
Category Required Skills and Knowledge five minutes. This includes assessing
Administration of the patient’s
o level of consciousness,
Sedative/ Pharmacology of sedatives and
o electrocardiogram,
Analgesic opioids
o heart rate,
Medications Treatment of oversedation
o blood pressure,
(eg, airway management,
o respiratory rate,
pharmacological reversal agents)
o oxygen saturation by pulse
Airway Skills oximetry, and
Airway assessment, including the o capnography (end-tidal carbon
ability to dioxide [CO2] monitoring)
o examine the airway and recognize a Ensure that resuscitative equipment
potentially difficult airway (eg, and rescue medications are available
significant obesity, obstructive
sleep apnea, short neck, limited Transport to the
neck motion, thyromental distance Postanesthesia Accompany and monitor the patient
less than 3 cm, small mouth Care Unit to the PACU
opening, macroglossia, (PACU) Administer oxygen via face mask
micrognathia) and Reference
o recognize signs of airway 1. American Society of Anesthesiologists. Statement on granting
obstruction (eg, snoring, rocking privileges for administration of moderate sedation to
motion of chest/abdomen, practitioners who are not anesthesia professionals. http://
capnography) www.asahq.org/w/media/Sites/ASAHQ/Files/Public/Resou
Ability to “rescue” a compromised rces/standards-guidelines/statement-on-granting-privileges
airway by head/neck reposition, jaw -for-administration-of-moderate-sedation-to-non-anesthesio
lift, insertion of an oral or nasal airway, logist.pdf. Accessed July 30, 2015.
and bag-mask ventilation
Resuscitation Skills
Basic life support (BLS) required patient-monitoring devices;
Advanced cardiac life support (ACLS) basic and advanced airway management equipment;
team available within five minutes an emergency cart with a monitor, defibrillator, or
Patient pacemaker;
Presedation Ability to advanced life support medications;
Evaluation o obtain a medical history from reversal or rescue agents; and
patient (eg, review of major organ vascular access equipment (Table 4).
systems, allergies, medications,
reactions to past sedation or
anesthesia, substance use disorder Monitoring
or chronic opioid therapy, time of Continuous patient monitoring during moderate sedation is
last oral intake) essential for patient safety. The nurse should record the pa-
o perform a physical examination of
the patient, including his or her
tient’s vital signs, including heart rate and rhythm, blood
airway, and perform pulmonary and pressure, oxygen saturation by pulse oximetry, and level of
cardiac auscultation consciousness. These are the minimum assessment parameters
o perform additional evaluation to be monitored, recorded every five minutes, and docu-
depending on patient
mented before, during, and after the procedure in the post-
comorbidities and American
Society of Anesthesiologists (ASA) sedation phase. The ASA also recommends the use of
physical status classification supplemental oxygen with intravenous sedation.1
Intraoperative Monitoring a patient’s pulse oximetry is the standard means of
Monitoring Monitor the patient’s vital signs
continuously and record results every detecting oxygen desaturation and hypoxemia during sedation/
analgesia; however, pulse oximetry is less than ideal in
(continued) detecting ventilatory compromise (eg, hypoventilation, airway

Table 2. Preoperative Factors That Prompt an Anesthesia Consult
American Society of
Anesthesiologist’s (ASA)
Classification1 Medical Description Examples Presence of Anesthesiologist
ASA 1 Healthy patient Healthy without medications Not needed unless special
indications
ASA 2 A patient with mild systemic Not needed unless special
diseasedno functional Mild asthma indications are present:
limitation Medically controlled Extremes of age (younger
hypertension than five years or older than
Well-controlled diabetes 80 years)
mellitus Morbid obesity
Sleep apnea
A difficult airway
Chronic pain on opioid
therapy
Substance use disorder
History of difficult sedation
Prior adverse reaction to
sedation/anesthesia
Long or complex procedure
planned
Use of the prone position is
planned
ASA 3 A patient with severe systemic Consider anesthesia
disease or definite functional Moderate to severe asthma consultation if there are
limitation Poorly controlled hypertension special indications:
Coronary artery disease Extremes of age (younger
than five years or older than
80 years)
Morbid obesity
Sleep apnea
A difficult airway
Chronic pain on opioid
therapy
Substance use disorder
History of difficult sedation
Prior adverse reaction to
sedation/anesthesia
Long or complex procedure
planned
Use of the prone position is
planned
ASA 4 A patient with severe systemic Consultation needed
disease that is a constant Severe chronic obstructive
threat to life pulmonary disease requiring
oxygen therapy
End-stage renal failure requiring
dialysis
Unstable angina
ASA 5 A moribund patient who is not Consultation needed
expected to survive without Septic shock
the operation Hemorrhagic shock
Reference
1. ASA Physical Status Classification System. American Society of Anesthesiologists. http://www.asahq.org/resources/clinical-information/
asa-physical-status-classification-system. Accessed July 15, 2015.

Table 3. Fasting Recommendations to Reduce the Table 4. Equipment for Sedation and Analgesia
1,a
Risk for Pulmonary Aspiration
In the OR Readily Available
Minimum Fasting High-Flow Oxygen Source Defibrillator/Pacer
Ingested Material Period
Suctioning Apparatus
Clear Liquidsb Two hours
Airway Management Equipment Emergency
Breast Milk Four hours Face Masks Medications
Infant Formula, Nonhuman Milk Six hours Oral and Nasal Airways in a Range of Epinephrine
Sizes Ephedrine
Light Meal (eg, toast and clear Six hours
Laryngeal Mask Airways Vasopressin
liquids)
Battery-Tested Laryngoscope Atropine
Fatty Meal Eight hours Handles Amiodarone
a
These recommendations apply to healthy patients who are Laryngoscope Blades in a Range of Lidocaine
undergoing elective procedures. See text for other Sizes Hydrocortisone
exceptions. Note that following the guidelines does not Cuffed and Uncuffed Pediatric Glucose 50%
guarantee that complete gastric emptying has occurred, and Endotracheal Tubes Diphenhydramine
patients with severe pain, diabetes mellitus, gastroesophageal Stylet Esmolol or
reflux, and other medical conditions may be at higher risk for Bag-Valve-Mask Device metoprolol
aspiration of gastric contents.
b
Examples of clear liquids include water, see-through fruit juices Vascular Access Equipment
without pulp, carbonated beverages, clear tea, and black Gloves
coffee without milk. Tourniquets
1. American Society of Anesthesiologists Committee. Practice Alcohol Wipes
guidelines for preoperative fasting and the use of IV Catheters (24 g, 20 g, 18 g)
pharmacologic agents to reduce the risk of pulmonary Syringes and Needles
aspiration: application to healthy patients undergoing elective
IV Fluids and Tubing
procedures: an updated report by the American Society of
Anesthesiologists Committee on Standards and Practice Basic Monitoring Equipment
Parameters. Anesthesiology. 2011;114(3):495-511. Electrocardiogram
Pulse Oximeter
Blood Pressure Cuff
Capnometer
obstruction, apnea). If the patient is monitored with pulse
oximetry alone, significant respiratory compromise and patient Supplemental Oxygen (O2) During
injury can occur despite normal oxygen saturation levels.5 Procedure
Reversal Agents
According to the ASA standards, the care provider should Naloxone
determine the patient’s adequacy of ventilation by continu- Flumazenil
ously observing his or her respiration and by monitoring end-
tidal carbon dioxide (CO2; ie, capnography) for the presence A range of 80 to 90 is consistent with sedation, and a range
of exhaled CO2.6 Capnography is more accurate for detecting of 40 to 60 is consistent with general anesthesia. Although
apnea than assessing the patient’s clinical ventilation. In a this technology has been widely used to monitor the depth
recent study in which the anesthesiologist was blinded to of hypnosis during general anesthesia, its applicability for the
capnography results, 10 of the 39 study patients developed purpose of sedation is controversial. Monitoring the BIS
20 seconds of apnea, which was missed by monitoring may be beneficial in preventing oversedation and reducing
clinical signs and pulse oximetry. This ventilatory the time to discharge.8
compromise was detected by capnography.7
The person administering sedation also can monitor the depth MEDICATIONS USED FOR SEDATION
of sedation by using processed electroencephalographic activity Before selecting agents, the care provider should consider
such as the bispectral index (BIS); however, its usefulness is whether the procedure will be painful, be prolonged, or
controversial. The BIS continuously processes the patient’s require the patient to be motionless, and weigh the risks and
electroencephalograph and was specifically developed to pro- benefits for the individual patient. Outlining and individual-
vide an estimate of the depth of consciousness. The BIS scores izing the goals for each patient helps formulate an appropriate
sedation range from 0 to 100.8 A BIS value of 100 is regimen that may involve the administration of either indi-
considered complete alertness, and 0 is no cortical activity. vidual or combined sedative and analgesic medications.

If the procedure is not painful (eg, magnetic resonance im- benzodiazepine dependence or a history of seizures because it
aging, radiological oncology, computed tomography), simple may precipitate life-threatening status epilepticus. Seizures
sedation may suffice and benzodiazepines alone may suffice. have been reported after the reversal of benzodiazepines even
The care provider should add analgesic agents (eg, opioids) to in non-benzodiazepine-dependent patients. For this reason,
any procedure that requires pain relief. Ketamine can be an routine reversal with flumazenil is not recommended.11
excellent single medication choice for painful or stimulating
procedures in children and for restricted adult applications (eg, Opioids (narcotics)
fracture reduction). Most often a combination of medications,
Opioids are administered for their analgesic properties. In the
consisting of benzodiazepines and analgesics, is a good choice.
context of procedural sedation, they are used to supplement
However, be aware when combining these medications that
other agents (eg, sedative-hypnotics) to provide optimal con-
side effects are frequently synergistic and can potentiate res-
ditions for patients to tolerate painful procedures. These med-
piratory depression and other adverse events.5
ications share the ability to interact with opiate receptors located
throughout the central nervous system (CNS) and inhibit
Specific Medications nociception (ie, the ability to perceive pain). Opioid selection is
A number of medications are commonly used for sedation. usually based on the medication’s onset and duration or its
These include benzodiazepines, opioids, and anesthetic med- adverse effects. Fentanyl, for example, has a rapid onset, short
ications. Table 5 shows the specific agents used for moderate duration of action, and stable cardiovascular profile and is a
sedation, their amnestic and analgesic properties, dosage popular opioid for moderate sedation. Fentanyl is highly lipid
recommendations for adult patients, and side effects. soluble and rapidly crosses the blood-brain barrier, causing
analgesia in less than 90 seconds for durations as long as 30 to
40 minutes. Administered in incremental small doses (eg, 25 mg
Benzodiazepines to 50 mg), it is very useful for short, painful procedures.12
These medications are administered for moderate sedation and
include midazolam and diazepam. Midazolam is commonly used The drawback of fentanyl is respiratory depression that
for moderate sedation because of its shorter duration of action. significantly overlaps its analgesic effects. The magnitude of
Benzodiazepines have antianxiety, anticonvulsant, sedative, respiratory depression can be greatly increased when fentanyl is
muscle relaxant, and amnesic properties. However, they do not used in combination with midazolam and other sedatives. It is
provide analgesia, and they are commonly coadministered with essential for the surgical team to monitor the patient with
opioids, which potentiate their effects. Care providers should pulse oximetry and capnography and provide supplemental
reduce doses of benzodiazepines in patients with hepatic or renal oxygen even when using small amounts of fentanyl. In small
disease and in patients who are elderly, critically ill, or obese. In concentrations, fentanyl has limited effects on cardiovascular
these patients, the clearance of midazolam is halved, leading to a function, although significant decreases in blood pressure may
prolonged half-life and excessive sedation. Adverse effects of occur with fentanyl/benzodiazepine combinations and in
benzodiazepine administration include pain on injection (diaz- critically ill or hypovolemic patients.
epam), birth defects in the first trimester of pregnancy, para-
doxical reactions (agitation), and dose-related hypoventilation, Opioids can be reversed by naloxone, which antagonizes all
hypoxemia, and hypotension, especially when using midazolam.9 the CNS effects of opioids, including respiratory depression,
excessive sedation, and analgesia. Naloxone should be titrated
Flumazenil is specifically used to reverse the sedative effects of slowly, in increments of 0.04 mg IV over one to two minutes
benzodiazepines. The onset of action is rapid (eg, one to two to the desired effect (eg, responsiveness to stimulation, an
minutes), peak effects occur within five to 10 minutes, and it increase in respiratory rate to more than eight breaths per
has a half-life of 45 to 90 minutes. Because the duration of minute). Absolute reversal of analgesia may precipitate sym-
flumazenil is shorter than most benzodiazepines, the possibility pathetic discharge manifested by hypertension, tachycardia,
of re-sedation exists, and continuous respiratory monitoring is and, in extreme situations, ventricular fibrillation and pul-
advised.10 Flumazenil is generally titrated in doses of 0.1 mg to monary edema. The effects of naloxone can be seen within one
0.2 mg IV every one to two minutes until the desired effect has to two minutes; however, the duration of reversal is rather
been observed. A dose of 1 mg is generally sufficient, but larger short (eg, 30 to 60 minutes) and re-sedation may occur if
doses (eg, a maximum of 5 mg) may be required to reverse the long-acting narcotics have been used. Because of naloxone’s
effects of benzodiazepines. Individuals administering sedation side effects, it is safest to administer appropriate doses of
should use flumazenil with extreme caution in patients with opioids in the first place rather than rely on reversal. If

532 j AORN Journal
MetznerdDomino
Table 5. Moderate Sedation Medication Dosage and Administration
Medication Sedation Anxiolysis Analgesia Route/Dose Onset (minutes) Peak (minutes) Duration (minutes) Comments
a
Sedatives/Hypnotics
Midazolam Yes Yes No IV: 0.5-1 mg (titrate to effect 0.5-1 3-5 10-30
up to max 5 mg) Minimal
cardiorespiratory
IM: 0.08 mg/kg 10-15 20-45 60-120
depression
PO: 0.5 mg/kg 15-30 35-45 60-90 Reduce dose when used
Diazepam Yes Yes No IV: 2-3 mg (titrate to effect 1-2 8-15 15-45 in combination with
up to 15 mg) opioids
Midazolam is the
PO: 5-10 mg 30-60 45-60 60-100 benzodiazepine of
choice for short
procedures
Antagonist: flumazenil
Opioids
Fentanyl No No Yes IV: 25-50 mg intermittent 1-2 5 30-40 Respiratory depression;
boluses decreased response to
hypercarbia and hypoxia
Synergistic sedative and
respiratory depressant
effects (reduce dose
with sedatives)
Nausea, vomiting
Meperidine: histamine
release
Antagonist: naloxone
Reversal Agents (ie, antagonists)
Flumazenil No No No IV: 0.1-0.2 mg (titrate to 1-2 5-10 45-90
effect to max 5 mg) Short-acting, repeat
November 2015, Vol. 102, No. 5

doses may be required
Avoid in patients
receiving
benzodiazepines for
seizure control
www.aornjournal.org
Caution with chronic

benzodiazepine therapy
(withdrawal effect) or
with tricyclic
antidepressants
(continued)
www.aornjournal.org
November 2015, Vol. 102, No. 5

Table 5. (continued )
Medication Sedation Anxiolysis Analgesia Route/Dose Onset (minutes) Peak (minutes) Duration (minutes) Comments
Naloxone No No No IV: 0.02-0.04 mg (titrate to 1-2 2-3 30-60

effect) Short-acting, repeat
doses may be required
May cause hypertension
and tachycardia
Pulmonary edema
reported
Anesthetics
Ketamine Yes No Yes IV: 0.2-0.5 mg/kg (titrate 1 1-2 10-20
to effect) Dissociative anesthetic
IM: 2-5 mg/kg 5 15 15-30 Emergence reactions
blunted with midazolam
Minimal respiratory
depression,
bronchodilator
Hypersalivation,
laryngospasm
Cardiac stimulant (ie,
increase in blood
pressure and heart rate)
Increase in intracranial
pressure and intraocular
pressure
Propofol Yes Yes No IV: 0.5 mg/kg (intermittent <1 1-2 5-8
boluses) Infusion: 25-75 Cardiorespiratory
mg/kg/min depression
Pain on injection
Antiemetic properties
Max ¼ maximum.
a
Alterations in dosing may be indicated based on the clinical situation and the practitioner’s experience with these agents. Individual dosages may vary depending on age and coexistent
diseases. Doses should be reduced for more ill patients and in the elderly. When using drug combinations, the potential for significant respiratory impairment and airway obstruction is
Moderate Sedation: A Primer

increased. Drugs should be titrated to achieve optimal effect, and sufficient time for dose-effect should be allowed before administering an additional dose or another medication.
AORN Journal j 533
naloxone is required to reverse an accidental opioid overdose, weight,

close monitoring of the patient for one to 1.5 hours is essential gender,
because of the possibility of late respiratory depression.13 age, and
concomitant disease.
Anesthetic medications
The presence of liver or renal failure does not significantly alter
On occasion, ketamine or propofol may be added for moderate
propofol’s pharmacokinetics; however, dose reduction is rec-
sedation, most often when an anesthesia provider performs the
ommended in the elderly because the volume of distribution
sedation. However, with proper training, patient selection, and
decreases with age.16
appropriate patient monitoring, these medications may be safely
administered by perioperative RNs. Nurses should check with Propofol is an appealing medication for moderate sedation/
their state boards of nursing and their facility to ensure that this analgesia because of its rapid onset/offset effect, clear-head
is within their scope of practice.14 In the future, new computer- recovery, and antiemetic effects. Nevertheless, propofol has
controlled infusion devices may make sedation even safer. many undesirable side effects, including respiratory depression,
severe hypotension, and pain on injection, especially when
Ketamine. Ketamine is a unique phencyclidine derivative administered through small peripheral veins. The most con-
because it possesses remarkable analgesic and amnesic properties, cerning property of propofol is that the therapeutic window of
unlike other anesthetic-hypnotics. Ketamine causes disconnection propofol is very narrow. After even a single dose of propofol,
between the thalamocortical and limbic systems, preventing the the depth of sedation may move quickly on the sedation
higher centers in the CNS from perceiving sensory (eg, auditory, continuum scale and become deep sedation or general anes-
visual) input or painful stimuli. This leads to a dissociative state, thesia. Hence, in most sedation settings, propofol adminis-
characterized by mental disconnection from the surroundings tration is limited to anesthesia providers.16
and deep analgesia. In small doses (ie, 10 mg to 20 mg IV in an
In the future, computerized target-controlled infusion (TCI)
adult), ketamine enhances analgesia with minimal respiratory
devices and patient-controlled systems (PCSs) may be used to
depression. It minimally depresses ventilatory drive, and the
administer propofol for moderate sedation. Currently, these
protective airway reflexes, including those of the laryngeal
systems are not approved by the US Food and Drug
muscles, are well preserved. Ketamine has sympathomimetic
Administration (FDA) for use in the United States. On the
effects and is a potent bronchodilator, which can increase blood
basis of the age and weight of the patient, the TCI system
pressure, heart rate, and cardiac output, although these effects are
calculates the starting dose of propofol and the subsequent
blunted with the concurrent administration of benzodiazepines.15
required infusion rate, achieving and maintaining a desired
The major side effect of ketamine is emergence delirium, target plasma concentration. A recent prospective study
which can be prevented by concurrent administration of found that a TCI dose of propofol that ranged from 2 mg/mL
benzodiazepines, such as midazolam. Fifteen percent to 30% to 5 mg/mL provided adequate sedation for gastrointestinal
of adult patients may experience hallucinations, nightmares, procedures of different degrees of difficulty without
and agitation at and after emergence when they have received increasing the risk for medication-related side effects.17 A
ketamine without other sedative agents. This effect is rare PCS allows the patient to self-administer medication in
among pediatric patients. Ketamine also stimulates oral se- response to pain; therefore, the patient must be conscious
cretions and may induce laryngospasm, particularly during enough to press the handheld button. Specialized pumps
light planes of general anesthesia. are used to deliver preset doses of medication in response
to a patient pressing a handheld button. A timed lockout
Propofol. This medication has potent sedative and hypnotic function prevents the patient from receiving additional
properties with minimal analgesic effects. Its high lipid solubility doses until the previous dose has taken its full effect.
quickly penetrates the CNS and is rapidly cleared from the blood, Researchers conducting a randomized crossover trial that
resulting in both a rapid onset of action and a quick recovery at compared propofol administered by IV boluses with PCSs
the doses used for procedural sedation. Propofol’s duration of and patient-maintained sedation using TCIs of propofol
action is very shortebetween two to eight minutes. The plasma found that the mean titration time to achieve adequate
concentration of propofol required for sedation depends on the sedation was longer with TCI devices than with PCSs (nine
targeted depth of sedation and is influenced by coadministration minutes versus six minutes).18 Both techniques provided
of other sedatives/analgesics. The pharmacokinetic actions of moderate sedation; however, two (9%) patients became
propofol are altered by a variety of factors, including oversedated using a PCS.

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CONCLUSION analgesia. American Association of Nurse Anesthetists. https://
www.aana.com/resources2/professionalpractice/Documents/PPM
The administration of moderate sedation is safe if qualified and
%20Consid%204.2%20RNs%20Engaged%20in%20Sedation%20
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17. Fanti L, Agostoni M, Casati A, et al. Target-controlled propofol
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Moderate Sedasi Di OK

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PATIENT

Moderate Sedation: A Primer for

E conomic pressures require health care to be more

Figure 1. The continuum of sedation.

www.aornjournal.org AORN Journal j 527

Table 1. Training and Credentialing in Moderate Table 1. (continued )

528 j AORN Journal www.aornjournal.org

Table 2. Preoperative Factors That Prompt an Anesthesia Consult

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November 2015, Vol. 102, No. 5

Caution with chronic

November 2015, Vol. 102, No. 5

Naloxone No No No IV: 0.02-0.04 mg (titrate to 1-2 2-3 30-60

Moderate Sedation: A Primer

naloxone is required to reverse an accidental opioid overdose, weight,

534 j AORN Journal www.aornjournal.org

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