Sedation and Analgesia for Diagnostic and Therapeutic Procedures – Part 1 doc

Sedation and Analgesia for Diagnostic and Therapeutic Procedures Edited by Shobha Malviya, MD Norah N. Naughton, MD Kevin K. Tremper, MD , P h D HUMANA PRESS HUMANA PRESS Humana Press Totowa, New Jersey SEDATION AND ANALGESIA FOR DIAGNOSTIC AND THERAPEUTIC PROCEDURES Edited by SHOBHA MALVIYA, MD, N ORAH N. NAUGHTON, MD, and KEVIN K. TREMPER, MD, PhD Department of Anesthesiology, University of Michigan Health System, Ann Arbor, MI Contemporary Clinical Neuroscience © 2003 Humana Press Inc. 999 Riverview Drive, Suite 208 Totowa, New Jersey 07512 humanapress.com All rights reserved. No part of this book may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise without written permission from the Publisher. All authored papers, comments, opinions, conclusions, or recommendations are those of the author(s), and do not necessarily reflect the views of the publisher. The content and opinions expressed in this book are the sole work of the authors and editors, who have warranted due diligence in the creation and issuance of their work. The publisher, editors, and authors are not responsible for errors or omissions or for any consequences arising from the information or opinions presented in this book and make no warranty, express or implied, with respect to its contents. Production Editor: Kim Hoather-Potter. Cover design by Patricia F. Cleary. For additional copies, pricing for bulk purchases, and/or information about other Humana titles, contact Humana at the above address or at any of the following numbers: Tel.: 973-256-1699; Fax: 973-256- 8341; E-mail: humana@humanapr.com or visit our website at www.humanapress.com The opinions expressed herein are the views of the authors and may not necessarily reflect the official policy of the National Institute on Drug Abuse or any other parts of the US Department of Health and Human Services. The US Government does not endorse or favor any specific commercial product or company. Trade, proprietary, or company names appearing in this publication are used only because they are considered essential in the context of the studies reported herein. This publication is printed on acid-free paper. ∞ ANSI Z39.48-1984 (American National Standards Institute) Permanence of Paper for Printed Library Materials. Photocopy Authorization Policy: Authorization to photocopy items for internal or personal use, or the internal or personal use of specific clients, is granted by Humana Press Inc., provided that the base fee of US $20.00 per copy, plus US $00.25 per page, is paid directly to the Copyright Clearance Center at 222 Rosewood Drive, Danvers, MA 01923. For those organizations that have been granted a photocopy license from the CCC, a separate system of payment has been arranged and is acceptable to Humana Press Inc. The fee code for users of the Trans- actional Reporting Service is: [0-89603-863-7/03 $20.00]. Printed in the United States of America. 10 9 8 7 6 5 4 3 2 1 Library of Congress Cataloging-in-Publication Data Sedation and analgesia for diagnostic and therapeutic procedures / [edited by] Shobha Malviya, Norah N. Naughton and Kevin K. Tremper. p. ; cm (Contemporary clinical neuroscience) Includes bibliographical references and index. ISBN 0-89603-863-7 (alk. paper) E-ISBN 1-59259-295-3 1. Anesthesia. 2. Analgesia. I. Malviya, Shobha. II. Naughton, Norah N. III. Tremper, Kevin K. IV. Series. [DNLM: 1. Anesthesia. 2. Analgesia. 3. Diagnostic Techniques and Procedures. WO 200 S4466 2003] RD81 .S39 2003 617.9'6 dc21 2002032817 Disclaimer: Some images in the original version of this book are not available for inclusion in the eBook. DEDICATION In memory of my parents Mr. Laxmi Narain Goel and Mrs. Janak Dulari Goel who gave me the privilege of learning. To my husband Vinay, and our children Samir and Sanjana with whom I continue to learn. Shobha Malviya, MD To Bridget, Julie, Michael, and Pat: your presence makes my dreams possible. Norah N. Naughton, MD v vii PREFACE Pharmacologically induced sedation has become pervasive throughout medical practice to accomplish diagnostic and minor therapeutic procedures effectively and humanely. As diagnostic techniques and technical proce- dures become more complex, the need for sedation in patients with varied co-morbid conditions, in diverse settings produces a series of questions regarding safety and effectiveness. The administration of sedation and anal- gesia for diagnostic and therapeutic procedures has therefore evolved into a unique discipline that is practiced by clinicians with varying skills and train- ing. Disparities in sedation practices have led regulatory agencies to man- date that patients receive the same standard of care regardless of the location in which the care is provided within an institution. To ensure that the stan- dard of care is of high quality, institutions are required to develop guidelines for the practice of sedation, ensure that these guidelines are followed, and provide quality data and outcome measures. In addition, practitioners who administer sedatives and analgesics specifically for a diagnostic and/or a therapeutic procedure require specific credentials for this practice. It is the intent of Sedation and Analgesia for Diagnostic and Therapeutic Procedures to review sedation and analgesia from a wide variety of per- spectives starting with the basic neurobiology and physiology of the sedated state, proceeding through clinical guidelines and practices, and concluding with a section on quality-outcome measures and processes. The practical aspects of this book have been further emphasized by incorporating a series of tables and figures in each chapter that highlight protocols, regulatory requirements, recommended dosages of pharmacologic agents, monitoring requirements, and quality assurance tools. The target audience for this text spans multiple disciplines that range from investigators, physicians, and nurses to hospital administrators. The editors are indebted to all the authors for contributing their knowledge, time, and effort. Special thanks are due to Dr. Ralph Lydic who conceived this project and to Ms. Terri Voepel-Lewis, MSN, RN for her invaluable assis- tance throughout the development of this text. Finally, we thank Mrs. Colleen Rauch and Mrs. Melissa Bowles for their administrative assistance. Shobha Malviya, MD Norah Naughton, MD Kevin K. Tremper, MD, PhD ix CONTENTS Dedication v Preface vii Contributors xi 1 Opioids, Sedation, and Sleep: Different States, Similar Traits, and the Search for Common Mechanisms 1 Ralph Lydic, Helen A. Baghdoyan, and Jacinta McGinley 2 Practice Guidelines for Pediatric Sedation 33 David M. Polaner 3 Practice Guidelines for Adult Sedation and Analgesia 53 Randolph Steadman and Steve Yun 4 Procedure and Site-Specific Considerations for Pediatric Sedation 77 Shobha Malviya 5 Adult Sedation by Site and Procedure 105 Norah N. Naughton 6 Pharmacology of Sedative Agents 125 Joseph D. Tobias 7 Opioids in the Management of Acute Pediatric Pain 153 Myron Yaster, Lynne G. Maxwell, and Sabine Kost-Byerly 8 Patient Monitoring During Sedation 191 Kevin K. Tremper 9 Assessment of Sedation Depth 219 Lia H. Lowrie and Jeffrey L. Blumer 10 Nursing Perspectives on the Care of Sedated Patients 243 Terri Voepel-Lewis 11 Recovery and Transport of Sedated Patients 263 Loree A. Collett, Sheila A. Trouten, and Terri Voepel-Lewis 12 Quality Assurance and Continuous Quality Improvement in Sedation Analgesia 275 J. Elizabeth Othman Index 297 [...]... for midazolam for EEG-derived parameters and saccadic peak velocity Br J Clin Pharmacol 36, 10 9 1 15 13 Roelofse, J A., Louw, L R., and Roelofse, P G (19 98) A double blind randomized comparison of oral trimeprazine-methadone and ketaminemidazolam for sedation of pediatric dental patients for oral surgical procedures Anesth Prog 45, 3 1 1 14 Ramsay MAE, Savege, T M., Simpson, B R J., and Goodwin, R (19 74)... J and Avery, D R (19 97) The effect of sleep on conscious sedation: A follow-up study J Clin Pediatr Dent 21, 13 1 1 34 10 Mahowald, M W and Schenck, C H (19 92) Dissociated states of wakefulness and sleep Neurology 42, 4 4–5 2 11 Aldrich, M S (19 99) Sleep Medicine, Oxford University Press, New York, NY 12 Van Steveninck, A L., Mandema, J W., Tuk, B., Van Dijk, J G., Schoemaker, H C., Danhof, M., et al (19 93)... concerning the cellular and molecular mechanisms that cause sedation Improved anesthetic drugs are a key factor contributing to enhanced anesthetic safety (16 6) Therefore, basic and clinical sedation research are essential for continued advances in patient safety and comfort Opioids, Sedation, and Sleep 21 ACKNOWLEDGEMENT Supported by NIH grants HL5 712 0, MH453 61, HL408 81, HL65272, and the Department of Anesthesiology... English, and M A Norat REFERENCES 1 Lydic, R and Baghdoyan, H A (eds) (19 99) Handbook of Behavioral State Control: Cellular and Molecular Mechanisms, CRC Press, Boca Raton, FL 2 Gross, J B., Bailey, P L., Caplan, R A., Connis, R T., Coté, C J., Davis, F G., et al (19 96) Practice guidelines for sedation and analgesia by nonanesthesiologists Anesthesiology 84, 45 9–4 71 3 Lydic, R and Biebuyck, J F (19 94)... descriptive data that now characterize sedation From: Contemporary Clinical Neuroscience: Sedation and Analgesia for Diagnostic and Therapeutic Procedures Edited by: S Malviya, N N Naughton, and K K Tremper © Humana Press Inc., Totowa, NJ 1 2 Lydic, Baghdoyan, and McGinley During sedation, the effects of pharmacological agents are superimposed on a patient’s emotional state and level of arousal A patient’s... relationship between EEG power, memory, and level of sedation Many of these studies aim to derive an EEG Opioids, Sedation, and Sleep 7 index for the quantitative assessment of arousal level or as a marker of amnesia There is good agreement for slowing of EEG frequency into the Beta range (Beta1 Х 1 5–2 0 Hz; Beta2 Х 20. 5–3 0 Hz) caused by midazolam (46) and propofol (4 7–4 9), and for EEG slowing caused by dexmedetomidine... relevance for mechanistic studies of anesthesia Br J Anaesth 72, 50 6–5 08 4 Lydic, R (19 96) Reticular modulation of breathing during sleep and anesthesia Curr Opin Pulm Med 2, 47 4–4 81 5 Mortazavi, S., Thompson, J., Baghdoyan, H A., and and Lydic, R (19 99) Fentanyl and morphine, but not remifentanil, inhibit acetylcholine release in pontine regions modulating arousal Anesthesiology 90, 10 7 0 1 077 6 Jastak,... T and Peskin, R M (19 91) Major morbidity or mortality from office anesthetic procedures: A closed-claim analysis of 13 cases Anesth Prog 38, 3 9–4 4 7 Kryger, M H., Roth, T., and Dement, W C (eds) (19 94) Principles and Practice of Sleep Medicine, 2nd ed., W B Saunders, Philadelphia, PA 8 Steriade, M., and McCarley, R W (19 90) Brainstem Control of Wakefulness and Sleep Plenum Press, New York, NY 9 Sanders,... operationally defining “procedural sedation (16 ), “monitored anesthesia care” (17 ), “conscious versus deep sedation (18 ), and sedation/ analgesia (2)? Practice guidelines recommend monitoring the level of consciousness during sedation (2 ,19 ) Therefore, a clear understanding of the similarities and differences between sedation and natural sleep are directly relevant to any objective assessment of arousal... Anesthesiology/Critical Care Medicine and Pediatrics, The Johns Hopkins Hospital, Baltimore, MD STEVE YUN, MD • UCLA School of Medicine, Center for Health Sciences, Los Angeles, CA Opioids, Sedation, and Sleep 1 1 Opioids, Sedation, and Sleep Different States, Similar Traits, and the Search for Common Mechanisms Ralph Lydic, PhD, Helen A Baghdoyan, PhD, and Jacinta McGinley, MB, FFARCSI 1 INTRODUCTION Sedation is an area . specifically for a diagnostic and/ or a therapeutic procedure require specific credentials for this practice. It is the intent of Sedation and Analgesia for Diagnostic and Therapeutic Procedures. Medicine, Center for Health Sciences, Los Angeles, CA Opioids, Sedation, and Sleep 1 1 From: Contemporary Clinical Neuroscience: Sedation and Analgesia for Diagnostic and Therapeutic Procedures Edited. Guidelines for Adult Sedation and Analgesia 53 Randolph Steadman and Steve Yun 4 Procedure and Site-Specific Considerations for Pediatric Sedation 77 Shobha Malviya 5 Adult Sedation by Site and Procedure