Transitioning into twilight: Procedural sedation

Susan, a 50-year-old female, came to the outpatient GI suites for colonoscopy screening as recommended by her primary care physician. Just prior to the scope, she was given midazolam (Versed), 1 mg IV push over 10 seconds. All vital signs were being monitored every 5 minutes. Her nurse noted that the patient's respiratory rate decreased from 24 to 12 breaths per minute, and her O₂ saturation, which started at 97%, was now at 88%. What seemed to be seconds later, Susan lost consciousness. The team quickly intubated her, opened up the intravenous fluids for rapid hydration, and closely monitored her. She regained consciousness, was stabilized, and the procedure was cancelled.

Assessing, establishing, and maintaining an adequate airway was crucial to Susan's recovery. Had there been an untrained or ill-prepared staff present, this routine procedure could have turned deadly. Although the root cause was initially theorized as patient dehydration, the nurse revisited the drug midazolam (Versed). As it turned out, 1 mg should have been slowly pushed over 1 to 2 minutes, not 10 seconds, as rapid administration could cause respiratory arrest.
A simple classification system exists that will help your team decide if procedural sedation would work for your patient:
 
While the term "conscious sedation" is no longer in vogue, "procedural sedation" (PS) occurs regularly in hospitals and clinics—and is often performed in areas other than a controlled operating room (OR). In fact, [healthcare]travelers practicing in facilities accredited by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) will likely be expected to administer sedation or analgesic agents for a variety of reasons—and to monitor patients' conditions. As PS becomes more commonplace, it is imperative for mobile providers not only to become familiar with the different levels of sedation, types of drugs used, and list of procedures warranting it, but also to recognize potential consequences.

You may read the original complete article by Teri Miller on Healthcare Traveler.