Procedural sedation and/or analgesia: a review

Abstract

INTRODUCTION: In recent decades procedural sedation and/or analgesia (PS/PSA) have been widely used for diagnostic examinations and minimally invasive surgical interventions outside of the operating room. The recommendations for (PS/PSA) presented in the literature contain contradictory data related to indications, contraindications, baseline monitoring level, priority level and sedation protocols. OBJECTIVE: To perform an analysis of current practice guidelines, randomized clinical trials (RCTs), literature review and to systematize data on the potential use of sedatives and narcotic analgesics in procedural sedation. MATERIALS AND METHODS: PubMed, Medline, Embase, and eLibrary were searched for PS/PSA guidelines, RCTs, and articles. RESULTS: The literature review describes the levels of sedation in increase in difficulty and potential risk of complications. A comparative characteristic of first- and second-line drugs for sedation and anesthesia is presented. Minimum requirements for perioperative monitoring of vital signs, sedation and pain levels are formulated. CONCLUSIONS: The PS/PSA in a planned or emergency procedure provides safe, comfortable and successful performance of diagnostic examinations and mini-invasive surgical interventions. The principles of interaction and administration of sedatives with narcotic analgesics are the basis for the use of sedation regimens. The use of scales has important practical value for monitoring the dynamics of sedation levels and for more fine management of sedation doses. There are no absolute contraindications for PS/PSA. PS/PSA is a popular area of practice for the anesthesiologist and resuscitator today. The Russian Federation's lack of regulatory documents on PS/PSA makes it necessary to develop guidelines.