Sedation

Published: 15/08/2019

Sedation

The use of sedation in clinical practice, particularly in non-theatre areas, is increasing and anaesthetists are frequently asked to oversee its administration. It is essential that CT 1/2 anaesthetic trainees understand what is meant by conscious sedation [“A technique in which the use of a drug or drugs produces a state of depression of the central nervous system enabling treatment to be carried out, but during which verbal contact with the patient is maintained throughout the period of sedation”] and how it is administered safely.

Learning outcomes:

To gain a fundamental understanding of what is meant by conscious sedation and the risks associated with deeper levels of sedation
To be able to describe the differences between conscious sedation and deeper levels of sedation, with its attendant risks to patient safety
Understands the particular dangers associated with the use of multiple sedative drugs especially in the elderly
To be able to manage the side effects in a timely manner, ensuring patient safety is of paramount consideration at all times
To be able to safely deliver pharmacological sedation to appropriate patients and recognise their own limitations

Core clinical learning outcome:

Provision of safe and effective sedation to ASA 1 and 2 adult patients, aged less than 80 years of age using a maximum of two short acting agents

NB: All competencies annotated with the letter ‘E’ can be examined in any of the components of the Primary examination identified in the FRCA examination blueprint on page B-99 or in the Final examination identified in the Final FRCA blueprint on page C72 of Annex C.

Knowledge

Competence	Description	Assessment Methods	GMP
CS_BK_01	Can explain: What is meant by conscious sedation and why understanding the definition is crucial to patient safety The differences between conscious sedation and deep sedation and general anaesthesia The fundamental differences in techniques /drugs used /patient safety That the significant risks to patient safety associated with sedation technique requires meticulous attention to detail, the continuous presence of a suitably trained individual with responsibility for patient safety, safe monitoring and contemporaneous record keeping	A,D,E	1,2,3
CS_BK_02	Describes the pharmacology of drugs commonly used to produce sedation	A,C,E	1
CS_BK_03	Explains the need for and means of monitoring the sedated patient including the use of commonly used sedation scoring systems	A,C,E	1,2
CS_BK_04	Describes how drugs should be titrated to effect and how the use of multiple drugs with synergistic actions can reduce the therapeutic index and hence the margin of safety	A,C,E	1,2
CS_BK_05	Describes the importance of recognising the following when multiple drug techniques are employed: Increased potential for adverse outcomes when two or more sedating/analgesic drugs are administered The importance of titrating multiple drugs to effect whilst recognising that the possibility of differing times of onset, peak effect and duration, can result in an unpredictable response Knowledge of each drugs time of onset, peak effect, duration of action and potential for synergism	A,C,E	1,2,3
CS_BK_06	Can list which sedative drugs should not be given to the elderly [over 80 years of age], with reasons	A,C,E	1,2,3,4
CS_BK_07	Can explain the minimal monitoring required during pharmacological sedation	A,C,E	1
CS_BK_08	Describes the indications for the use of conscious sedation	A,C,E	1,2
CS_BK_09	Describes the risks associated with conscious sedation including [but not exclusively] those affecting the respiratory and cardiovascular systems	A,C,E	1,2
CS_BK_10	Can explain the use of single drug, multiple drug and inhalation techniques	A,C,E	1,2
CS_BK_11	Describes the particular risks of multiple drug sedation techniques	A,C,E	1,2,3
CS_BK_12	Outlines the unpredictable nature of sedation techniques in children [Cross ref paediatrics]	A,C,E	1,2,3
CS_BK_13	Explains the need for robust recovery and discharge criteria when conscious sedation is used for outpatient procedures and the importance of ensuring appropriate escort arrangements are in place [Cross ref day surgery]	A,C,E	1,2,3

Skills

Competence	Description	Assessment Method	GMP
CS_BS_01	Demonstrates the ability to select patients for whom sedation is an appropriate part of clinical management	A,C,D	1,2,3
CS_BS_02	Demonstrates the ability to explain sedation to patients and to obtain consent	A,D	1,2,3
CS_BS_03	Demonstrates the ability to administer and monitor inhalational sedation to patients for clinical procedures [Cross ref obstetrics]	A,D	1,2,3
CS_BS_04	Demonstrates the ability to administer and monitor intravenous sedation to patients for clinical procedures	A,D	1,2,3
CS_BS_05	Demonstrates the ability to recognise and manage the complications of sedation techniques appropriately, including recognition and correct management of loss of verbal responsiveness	A,D	1,2,3