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Published on 18.08.2019
The key points of the Swiss recommendations are multidisciplinary acceptance, advanced preoperative evaluation and selection of patients, clear safety recommendations and minimal requirements regarding monitoring, documentation and staff.
Sedation level | Conscious-ness | Reaction to stimuli | Spontaneous breathing | Protective reflex | Circulation | Intervention |
---|---|---|---|---|---|---|
I minimal | Awake | Normal on call | Normal | Normal | Normal | None |
II moderate | Drowsy | Wakeable Normal on call | Adequate | Normal | Generally normal | None |
III deep | Sleeping | Not wakeable, reaction to pain | Maybe impaired | Maybe impaired | Generally normal | Maybe secure airway, ventilation |
IV anaesthesia | Unconscious | No reaction | Insufficient or missing | Missing | Generally compromised | Secure airway ventilation |
Locality | The outpatient analgosedation performed by non-anaesthesiologists in medical practice is limited to a planned light to moderate sedation depth (level I–II according to table 1). |
Liability | Instructions (SOP) with sedation and analgesia in the hospital area must be prepared in consultation with the local anaesthesia service. |
Ability | The treatment team is able to detect and adequately treat complications such as deep sedation, hypercapnia and apnoea, hypoxia or cardiopulmonary instability. |
Quality | The structural and medical quality requirements are to be weighted according to priority and consequence in everyday clinical practice. |
Common risk factors | Additional diseases that required hospitalisation |
Coronary heart disease with angina pectoris | |
Relevant pulmonary disease with long-term oxygen therapy or O2 saturation <90% on ambient air | |
Heart failure with orthopnoea | |
Obesity (body mass index >35 kg/m2) | |
Contraindications for the appropriate sedatives and analgesics | |
Additional risk factors, which have to be considered according to the intended procedure and the method of analgosedation | Old age (reduced organ reserves) |
Neurological and psychiatric deficits (cooperation and communication) | |
Neuromuscular disorders | |
Craniofacial anomaly or pathology (“difficult airway”) | |
High risk of aspiration (e.g. ileus) | |
Severe sleep apnoea syndrome | |
Pregnancy |
Mandatory | Pulse oxymetry |
Venous access | |
Oxygen supply | |
Resuscitator bag with O2 connection and reservoir | |
Suction device | |
Equipment for airway access and management | |
Non-invasive blood pressure measurement | |
Defibrillator and resuscitation drugs | |
Recommended | Electrocardiography |
Capnometry | |
Inductive breating rate measurement |
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