J Korean Med Assoc Search

CLOSE


J Korean Med Assoc > Volume 52(6); 2009 > Article
Choi: Monitored Anesthesia Care and Sedation/Analgesia Outside the Operating Room

Abstract

In the modern era of medical practice, monitored anesthesia care (MAC) or sedation/analgesia in remote locations outside of the operating room has become a necessity, while working in a different environment poses additional challenge to the anesthesiologists. MAC minimizes anxiety, pain and discomfort during procedures or surgery under local anesthesia, resulting in improvement of patient's satisfaction and cooperation. Since complications associated with sedation are not rare, MAC or sedation/analgesia should be performed under appropriate circumstances and only when adequate resuscitative equipment and well-trained personnel are available. Anesthesia and procedural sedation outside of the operating room continue to show rapid growth, therefore, practical guidelines for sedation/analgesia are needed to improve quality of care and to provide a high level of patient safety and comfort.

References

1. Seip B, Huppertz-Hauss G, Sauar J, Bretthauer M, Hoff G. Patients' satisfaction: an important factor in quality control of gastroscopies. Scand J Gastroenterol 2008;43:1004-1011.

2. Imagawa A, Fujiki S, Kawahara Y, Matsushita H, Ota S, Tomoda T, Morito Y, Sakakihara I, Fujimoto T, Taira A, Tsugeno H, Kawano S, Yagi S, Takenaka R. Satisfaction with bispectral index monitoring of propofol-mediated sedation during endoscopic submucosal dissection: a prospective, randomized study. Endoscopy 2008;40:905-909.

3. Madan AK, Tichansky DS, Isom J, Minard G, Bee TK. Monitored anesthesia care with propofol versus surgeon-monitored sedation with benzodiazepines and narcotics for preoperative endoscopy in the morbidly obese. Obes Surg 2008;18:545-548.

4. American Society of Anesthesiologists (ASA). Position on monitored anesthesia care 1997;Park Ridge, Illinois: American Society of Anesthesiologists. 413.

5. McQuaid KR, Laine L. A systematic review and meta-analysis of randomized, controlled trials of moderate sedation for routine endoscopic procedures. Gastrointest Endosc 2008;67:910-923.

6. Pino RM. The nature of anesthesia and procedural sedation outside of the operating room. Curr Opin Anaesthesiol 2007;20:347-351.

7. Heo HJ, Han JI, Kim CH, Lee GY. Optimal infusion rates of remifentanil during propofol anesthesia for monitored anesthesia care in patient undergoing varicose vein endovenous laser therapy. Korean J Anesthesiol 2008;54:411-415.

8. Song IS, Yoo YC, Yang WY, Park J. Effective intravenous conscious sedation using MAC (Monitored Anaesthesia Care) and BIS (Bispectral Index) in plastic surgery field. J Korean Soc Aesthetic Plast Surg 2005;11:40-44.

9. American Society of Anesthesiologists Task Force on Sedation and Analgesia by Non-Anesthesiologists. Practice guidelines for sedation and analgesia by non-anesthesiologists. Anesthesiology 2002;96:1004-1017.

10. Cohen LB, Hightower CD, Wood DA, Miller KM, Aisenberg J. Moderate level sedation during endoscopy: a prospective study using low- dose propofol, meperidine/fentanyl, and midazolam. Gastrointest Endosc 2004;59:795-803.

11. Sipe BW, Scheidler M, Baluyut A, Wright B. A prospective safety study of a low-dose propofol sedation protocol for colonoscopy. Clin Gastroenterol Hepatol 2007;5:563-566.

12. Shabanie A. Conscious sedation for interventional procedures: a practical guide. Tech Vasc Interv Radiol 2006;9:84-88.

13. Neilson GA, Lennox PH. Sedation and anesthesia for interventional oncology. Semin Roentgenol 2007;42:150-163.

14. Zomorodi K, Donner A, Somma J, Barr J, Sladen R, Ramsay J, Geller E, Shafer SL. Population pharmacokinetics of midazolam administered by target controlled infusion for sedation following coronary artery bypass grafting. Anesthesiology 1998;89:1418-1429.

15. Badrinath S, Avramov MN, Shadrick M, Witt TR, Ivankovich AD. The use of a ketamine-propofol combination during monitored anesthesia care. Anesth Analg 2000;90:858-862.

16. Deng XM, Xiao WJ, Luo MP, Tang GZ, Xu KL. The use of midazolam and small-dose ketamine for sedation and analgesia during local anesthesia. Anesth Analg 2001;93:1174-1177.

17. Rex DK. Review article: moderate sedation for endoscopy: sedation regimens for non anaesthesiologists. Aliment Pharmacol Ther 2006;24:163-171.

18. Sá Rêgo MM, Inagaki Y, White PF. Remifentanil administration during monitored anesthesia care: Are intermittent boluses an effective alternative to a continuous infusion? Anesth Analg 1999;88:518-522.

19. Servin F, Desmonts JM, Watkins WD. Remifentanil as an analgesic adjunct in local/regional anesthesia and in monitored anesthesia care. Anesth Analg 1999;89:28-32.

20. Avramov MN, Smith I, White PF. Interactions between midazolam and remifentanil during monitored anesthesia care. Anesthesiology 1996;85:1283-1289.

21. Philip BK, Scuderi PE, Chung F, Conahan TJ, Maurer W, Angel JJ, Kallar SK, Skinner EP, Jamerson BD. Remifentanil compared with alfentanil for ambulatory surgery using total intravenous anesthesia. The Remifentanil/Alfentanil Outpatient TIVA Group. Anesth Analg 1997;84:515-521.

22. Smith I, Monk TG, White PF, Ding Y. Propofol infusion during regional anesthesia: sedative, amnestic, and anxiolytic properties. Anesth Analg 1994;79:313-319.

23. Patel S, Vargo JJ, Khandwala F, Lopez R, Trolli P, Dumot JA, Conwell DL, Zuccaro G. Deep sedation occurs frequently during elective endoscopy with meperidine and midazolam. Am J Gastroenterol 2005;100:2689-2695.

24. Koniaris LG, Wilson S, Drugas G, Simmons W. Capnographic monitoring of ventilatory status during moderate (conscious) sedation. Surg Endosc 2003;17:1261-1265.

25. Rampil IJ. A primer for EEG signal processing in anesthesia. Anesthesiology 1998;89:980-1002.

26. Qadeer MA, Vargo JJ, Patel S, Dumot JA, Lopez AR, Trolli PA, Conwell DL, Stevens T, Zuccaro G Jr. Bispectral index monitoring of conscious sedation with the combination of meperidine and midazolam during endoscopy. Clin Gastroenterol Hepatol 2008;6:102-108.

27. Johansen JW. Update on bispectral index monitoring. Best Pract Res Clin Anaesthesiol 2006;20:81-99.

28. Chernik DA, Gillings D, Laine H, Hendler J, Silver JM, Davidson AB, Schwam EM, Siegel JL. Validity and reliability of the Observer's Assessment of Alertness/Sedation Scale: study with intravenous midazolam. Clin Psychopharmacol 1990;10:244-251.

29. Weaver CS, Hauter WH, Duncan CE, Brizendine EJ, Cordell WH. An assessment of the association of bispectral index with 2 clinical sedation scales for monitoring depth of procedural sedation. Am J Emerg Med 2007;25:918-924.

30. Smith I. Monitored anesthesia care: how much sedation, how much analgesia? J Clin Anesth 1996;8:76-80.

Table 1
Commonly used sedative and analgesic drugs during MAC
jkma-52-592-i001-l.jpg
Table 2
Definitions of levels of sedation/ analgesia and general anesthesia
jkma-52-592-i002-l.jpg

Adapted from (9).

Table 3
Observer's assessment of alertness/sedation (OAA/S) scale
jkma-52-592-i003-l.jpg

Adapted from (28).

TOOLS
Share :
Facebook Twitter Linked In Google+ Line it
METRICS Graph View
  • 0 Crossref
  •   Scopus
  • 1,213 View
  • 6 Download
Related articles in
J Korean Med Assoc

The current state of sedation outside the operating room2013 April;56(4)



ABOUT
ARTICLE CATEGORY

Browse all articles >

ARCHIVES
FOR CONTRIBUTORS
Editorial Office
37 Ichon-ro 46-gil, Yongsan-gu, Seoul
Tel: +82-2-6350-6562    Fax: +82-2-792-5208    E-mail: jkmamaster@gmail.com                

Copyright © 2024 by Korean Medical Association.

Developed in M2PI

Close layer
prev next