%PDF-1.5 % Our mission is to Empower, Unite, and Advance every nurse, student, and educator. Achievement of all PACU discharge criteria and all phase II discharge criteria met, b. d. Physician evaluation is used in place of discharge criteria or discharge score. We also have am ambulatory surgical center for minor cases which operates completely separate from the main OR. : Midazolam/fentanyl, propofol/alfentanil, or alfentanil only for colonoscopy: A randomized trial. In the absence of the physician responsible for the discharge, the PACU nurse shall determine that the patient meets the discharge criteria. See how ASA is working to resolve three key economic issues that are impacting you, explore the resources of ASAs Payment Progress initiative, and test your anesthesia payment literacy! Further, because of continual traffic between the operating suite and the PACU, the two are usually located near one another within a hospital. American Society of Anesthesiologists: Continuum of depth of sedation: Definition of general anesthesia and levels of sedation/analgesia. Conscious sedation for interventional neuroradiology: A comparison of midazolam and propofol infusion. Recently, these discharge criteria have also been used in the operating room (OR) to determine the fast-track eligi-bility of outpatients undergoing ambulatory surgery (2,3). The effect of Ro15-1788 (Anexate) on conscious sedation produced with midazolam. In some cases, the choice of agents or techniques are limited by federal, state, or municipal regulations or statutes. 3. Midazolam sedation for outpatient fibreoptic endoscopy: Evaluation of alfentanil supplementation. Recovery from sedation with remifentanil and propofol, compared with morphine and midazolam, for reduction in anterior shoulder dislocation. During transport to the PACU, a patient should be accompanied and constantly evaluated and supported by a member of the anesthesia team knowledgeable about the patients condition. Specifically, the guidelines recommend regular monitoring for and support of the following: a. Airway patency, respiratory rate, and oxygen saturation, a. Pulse, blood pressure, and/or electrocardiographic monitoring, b. Euvolemia judged by hemodynamics and the balance of fluid intake and output (including the output of urine and surgical drains), a. Propofol sedation for upper gastrointestinal endoscopy in patients with liver cirrhosis as an alternative to midazolam to avoid acute deterioration of minimal encephalopathy: A randomized, controlled study. Level 1: The literature contains a sufficient number of RCTs to conduct meta-analysis, and meta-analytic findings from these aggregated studies are reported as evidence. The trauma of an operation and the residual effects of anesthetic drugs alter human physiology in predictable ways. Patient is awake, alert, responds to commands appropriate to age, or returned to pre-procedure status. The name of the physician accepting responsibility for discharge shall be noted on the record. Capnographic monitoring reduces the incidence of arterial oxygen desaturation and hypoxemia during propofol sedation for colonoscopy: A randomized, controlled study (ColoCap Study). The purposes of these guidelines are to allow clinicians to optimize the benefits of moderate procedural sedation regardless of site of service; to guide practitioners in appropriate patient selection; to decrease the risk of adverse patient outcomes (e.g., apnea, airway obstruction, respiratory arrest, cardiac arrest, death); to encourage sedation education, training, and research; and to offer evidence-based data to promote cross-specialty consistency for moderate sedation practice. Stability of vital signs, including temperature 3. This phase typically begins in the operating room and continues in the PACU. Meet American Society of PeriAnesthesia Nurses (ASPAN) Standards of Perianesthesia Nursing Practice 2008-2010. hbbd```b``Z"@$f"H 0{-&Y"DH7n"=f$6& H2veo e`g U Seven respondents (13.46%) indicated that there would be an increase in the amount of time, with four of these respondents estimating an increase ranging from 5 to 15min. The consultants, ASA members, and ASDA members agree that the designated individual may assist with minor, interruptible tasks once the patients level of sedation/analgesia and vital signs have stabilized, provided that adequate monitoring for the patients level of sedation is maintained; the AAOMS members strongly agree with this recommendation. 4. Use of discharge criteria shown to reduce PACU time by 24%. In this scenario we are not sure what the "extended level of care" might be. Procedural sedation with propofol for painful orthopaedic manipulation in the emergency department expedites patient management compared with a midazolam/ketamine regimen: A randomized prospective study. Discharge criteria must be applied consistently. Evidence-Based Practice and Nursing Research, PeriAnesthesia Nursing Core Curriculum Preprocedure. Most of these occurred in the era before pulse oximeters became widely used. Cherry Hill, N.J.: American . Applied when patient is admitted to PACU as part of nursing assessment, 3. Does nasal oxygen reduce the cardiorespiratory problems experienced by elderly patients undergoing endoscopic retrograde cholangiopancreatography? b. The comparison of dexmedetomidine and midazolam used for sedation of patients during upper endoscopy: A prospective, randomized study. In addition, the literature is insufficient to evaluate whether the presence of an individual dedicated to patient monitoring will reduce adverse outcomes related to moderate sedation/analgesia. %PDF-1.7 Discharge criterion: a standard or test by which to judge or decide whether a PACU patient is discharge ready. ASPAN standards for staffing? The guidelines exclude patients who are not undergoing a diagnostic or therapeutic procedure (e.g., postoperative analgesia). %PDF-1.6 % Sedation with ketamine and low-dose midazolam for short-term procedures requiring pharyngeal manipulation in young children. General medical supervision and coordination of patient care in the PACU should be the responsibility of an anesthesiologist. 5. Phase II discharge Reevaluate the patient immediately before the procedure. Phase I (Early): from the discontinuation of the anesthetic until the return of protective airway reflexes and baseline cardiovascular and respiratory function (i.e., when patient meets PACU discharge criteria described below). These recommendations may be adopted, modified, or rejected according to clinical needs and constraints and are not intended to replace local institutional policies. A complete bibliography used to develop these guidelines, arranged alphabetically by author, is available as Supplemental Digital Content 1, http://links.lww.com/ALN/B594. The ASA Committee on Standards and Practice Parameters reviews all practice guidelines at the ASA annual meeting and determines update and revision timelines. Phase 2 (Intermediate): starts when the patient meets PACU discharge criteria. Discharge readiness: the state of being ready to leave the PACU and be cared for in a less intensive nursing environment, 3. Stanford Hospital And Clinics OR REGION DISCHARGE CRITERIA FOR PHASE I & II- POST ANESTHESIA CARE ORAM D 4.05 Issued: 10/02 Last revision/review: 4/10 2 A. 33 0 obj <>/Filter/FlateDecode/ID[<82EC1363F47B6FA4F07401488ABAAFF0><0F1D02B4EFA2BC4DB6E3B193BC57958C>]/Index[10 39]/Info 9 0 R/Length 111/Prev 125561/Root 11 0 R/Size 49/Type/XRef/W[1 3 1]>>stream Create well-written care plans that meets your patient's health goals. Additional interventions excluded from these guidelines include but are not limited to patient-controlled sedation/analgesia, sedatives administered before or during regional and central neuraxis anesthesia, premedication for general anesthesia, interventions without sedatives (e.g., hypnosis, acupuncture), new or rarely administered sedative/analgesics, new or rarely used monitoring or delivery devices, and automated sedative delivery systems. Several retrospective, single-center studies have examined the prevalence and types of postoperative complications in the recovery room. At our hospital phase 2 is only for patients being discharged to home. In multiple studies over the past few decades, the two most common life-threatening postoperative complications affecting patients have been respiratory insufficiency and cardiovascular instability. Practitioners are cautioned that acute reversal of opioid-induced analgesia may result in pain, hypertension, tachycardia, or pulmonary edema. %PDF-1.6 % A literature search strategy and PRISMA* flow diagram are available as Supplemental Digital Content 2, http://links.lww.com/ALN/B597. Reversal of central benzodiazepine effects by intravenous flumazenil after conscious sedation with midazolam and opioids: A multicenter clinical study. The survey rate of return was 81% (n = 129 of 159) for consultants. Falls in hemoglobin saturation during ERCP and upper gastrointestinal endoscopy. 1. Standard V: Physician is responsible for the discharge of the patient from the post anesthesia care unit. hb``e`` Specializes in Post Anesthesia, Pre-Op. Patients receiving conscious sedation can either be brought to the PACU or delivered to stage 2 recovery (see Phases of Postanesthetic Recovery in this chapter) at the discretion of the anesthesiologist. Reported by authors as oxygen desaturation to at most 95% or oxygen desaturation more than 5 or 10% below baseline. Findings from the aggregated literature are reported in the text of these guidelines by evidence category, level, and direction. %%EOF For these guidelines, analgesia refers to the management of patient pain or discomfort during and after procedures requiring moderate sedation. What factors are associated with the difficult-to-sedate endoscopy patient? Implications: Most patients are stabilized immediately after surgery in a postanesthesia care unit (PACU) until their discharge to a hospital ward. Supports physician and nursing critical judgment of discharge readiness. Although it is well accepted clinical practice to review medical records, conduct a physical examination, and review laboratory test results, comparative studies are insufficient to evaluate the periprocedural impact of these activities. five . By reviewing the ASPAN Standards related to outpatient discharge criteria it was identified Applied routinely (every 15 or 30 minutes depending on institutional policy) as part of a nursing assessment, 4. Comparison of midazolam plus propofol with propofol alone for upper endoscopy: A prospective, single blind, randomized clinical trial. The use of practice guidelines cannot guarantee any specific outcome. Further, modern PACU discharge criteria emphasize respiratory and cardiac stability as a prerequisite to PACU discharge (see PACU Discharge Criteria in this chapter). When sedation/analgesia is administered to outpatients, medical supervision may not be available once the patient leaves the medical facility. The policy of the ASA Committee on Standards and Practice Parameters is to update practice guidelines every 5 yr. The PACU team cares for patients in all age ranges and all levels of acuity including ambulatory, inpatient, and critical care. endstream endobj 386 0 obj <. In October 2014, the American Society of Anesthesiologists Committee on Standards and Practice Parameters recommended that new practice guidelines addressing moderate procedural sedation and analgesia be developed. The member of the Anesthesia Care Team shall remain in the PACU until the PACU nurse accepts responsibility for the nursing care of the patient. ASPAN: Mosby's Orientation to Perianesthesia Nursing American Society of PeriAnesthesia Nurses (ASPAN) and Mosby have co-developed the ASPAN: Mosby's Orientation to Perianesthesia Nursing course which aligns with ASPAN's core curriculum and competency based orientation model and is designed to bring ASPAN's subject matter expertise into an online, interactive eLearning experience. 3rd ed. Relevant discharge criteria rigorously applied to determine the readiness of the patient for discharge, b. A PADSS score of 8 is required for discharge home. Put me out doc: Ketamine versus etomidate for the reduction of orthopedic dislocations. Practice guidelines for sedation and analgesia by non-anesthesiologists: An updated report. Phase II recovery focuses on preparing patients for hospital discharge, including education regarding the surgeon's postoperative instructions and any prescribed discharge medications. They provide basic recommendations that are supported by a synthesis and analysis of the current literature, expert and practitioner opinion, open forum commentary, and clinical feasibility data. Notably, all ambulatory surgery patients. For ambulatory surgery patients, this often takes 1 to 3 days. Does It Matter? 2. We are a 14 bed inpatient PACU. (xm/cK0'=&x;A=6B[3Nvd` !0;p_S&{qfLt5] y3YaN87IRA)Euk&krU|Ea A5.%.l4jjk@)c]OpR)VUr1Y$2,o7Zk90l"o For rare uncooperative patients (e.g., children with autism spectrum disorder or attention deficit disorder) recording oxygenation status or blood pressure may not be possible until after sedation. The Perianesthesia RN#s scope includes, but is not limited to, the preadmission assessment/process, Post Anesthesia Care Unit (Phase 1), Phase 2 recovery/discharge. For these guidelines, sedatives intended for general anesthesia include propofol, ketamine and etomidate. Sedatives not intended for general anesthesia (e.g., benzodiazepines, nitrous oxide, chloral hydrate, barbiturates, and antihistamines) are included either as comparison groups or in combination with sedatives intended for general anesthesia. Findings from these RCTs are reported separately as evidence. The rate of return was 34.6% (n = 55 of 159). Surgery results in bleeding, nonhematologic volume losses (e.g., evaporative and interstitial), and inflammation. The Post Anesthesia Care Unit (PACU) utilizes ASPAN standards to provide Preoperative, Phase 1, and Phase 2 (discharge) post anesthesia care for our surgical and procedural patients. Remifentanil, propofol or both for conscious sedation during eye surgery under regional anaesthesia. Full Time position. Surgery Phase, PACU Phase I, Phase II and Extended Care PR 4 Recommended Competencies for the Perianesthesia Nurse PR 5 Competencies of Perianesthesia . A. xwTS7PkhRH H. f. Discharge readiness may be attained before ready to transfer. 2. A comparative evaluation of intranasal dexmedetomidine, midazolam and ketamine for their sedative and analgesic properties: A triple blind randomized study. Immediately available in the procedure room refers to accessible shelving, unlocked cabinetry, and other measures to assure that there is no delay in accessing medications and equipment during the procedure. Guidelines, Statements, Clinical Resources, ASA Physical Status Classification System, Executive Physician Leadership Program II, Professional Development - The Practice of Anesthesiology, MIPS (Merit-based Incentive Payment System), Anesthesia SimSTAT: Simulated Anesthesia Education, Cardiovascular Implantable Electronic Devices, Electronic Media and Information Technology, Quality Management and Departmental Administration, ASA ADVANCE: The Anesthesiology Business Event, Anesthesia Quality and Patient Safety Meeting Online, Simulation Education Network (SEN) Summit, AIRS (Anesthesia Incident Reporting System), Guide for Anesthesia Department Administration, Medicare Conversion Factors for Anesthesia Services by Locale, Resources on How to Complete a RUC Survey, Foundation for Anesthesia Education and Research. Accessed on August 21, 2017). Immediately available in the procedure room refers to easily accessible shelving, cabinetry, and other measures to assure that there is no delay in accessing medications and equipment during the procedure. Aspects of care include assessment . endstream endobj 542 0 obj <. allnurses is a Nursing Career & Support site for Nurses and Students. These standards apply to postanesthesia care in all locations. endstream endobj 11 0 obj <> endobj 12 0 obj <> endobj 13 0 obj <>stream endstream endobj 15 0 obj <>stream that discharge criteria for Phase II did not include all the Standards. Soon after the discovery of the anesthetic properties of ether, which opened the door to a considerable growth in surgery, Florence Nightingale suggested in 1863 that postoperative patients in the U.S. be cared for in a specialized ward. 8. Pulse oximetry during minor oral surgery with and without intravenous sedation. Severe prolonged sedation associated with coadministration of protease inhibitors and intravenous midazolam during bronchoscopy. They are subject to revision from time to time as warranted by the evolution of technology and practice. These guidelines focus specifically on the administration of moderate sedation and analgesia for adults and children. Phase 2 assessments are the same as phase 1 but DVT propholaxis is indicated in phase 2 the patient is encourage to eat, drink, and ambulate if not contraindicated. A point score of 2 is assigned when the patient is fully awake, able to answer questions and call for assistance. Conclusion: It is anticipated that a new scoring tool will be instituted as the discharge protocol for Phase I PACU. Comparison of propofol-based sedation regimens administered during colonoscopy. Conscious sedation with propofol in elderly patients: A prospective evaluation. Category A evidence represents results obtained from randomized controlled trials (RCTs), and category B evidence represents observational results obtained from nonrandomized study designs or RCTs without pertinent comparison groups. ASPAN recommends assessing and documenting vital signs at least every 15 minutes during the first hour and then every 30 minutes until discharge from Phase I PACU care.5 The patient is then transitioned to Phase II, the inpatient setting, or the intensive care unit (ICU) for continued care.6 Awareness and collaboration Staffing should reflect 2. Can be supported by testing the criterion against future predictions, 7. Used to monitor intraoperative and postanesthesia interventions for effectiveness during quality assurance activities, 5. Create well-written care plans that meets your patient's health goals. PeriAnesthesia Nursing Core Curriculum: Preprocedure, Phase I and Phase II PACU Nursing. Discharge score attained within acceptable range set by policy. Choosing a specialty can be a daunting task and we made it easier. Hypoxia and tachycardia during endoscopic retrograde cholangiopancreatography: Detection by pulse oximetry. Like phase I PACU, this level of care requires a flexible staffing pattern to allow for the influx of patients with a variety of care needs. We need help! Developed By: Committee on Standards and Practice Parameters Original standards published in 1973 B. Ensure patient safety by integrating the Standards as criteria for Phase II discharge. Feasibility of a cardiologist-only approach to sedation for electrical cardioversion of atrial fibrillation: A randomized, open-blinded, prospective study. (Committee Chair and Task Force Co-Chair), Chicago, Illinois; Jeffrey B. endstream endobj 16 0 obj <>stream This document replaces the Practice Guidelines for Sedation and Analgesia by Non-Anesthesiologists: An Updated Report by the American Society of Anesthesiologists (ASA) Task Force on Sedation and Analgesia by Non-Anesthesiologists, adopted in 2001 and published in 2002.1. Guide practice decisions without dictating practice. Level 1: The literature contains nonrandomized comparisons (e.g., quasiexperimental, cohort [prospective or retrospective], or case-control research designs) with comparative statistics between clinical interventions for a specified clinical outcome. Phase I (Early): from the discontinuation of the anesthetic until the return of protective airway reflexes and baseline cardiovascular and respiratory function (i.e., when patient meets PACU discharge criteria described below). Information concerning the preoperative condition and the surgical/anesthetic course shall be transmitted to the PACU nurse. All main OR patients (with the exception of ICU patients) go to phase 1 (main recovery room) until they meet the requirements of stability. A nonrandomized comparative study reported equivocal outcomes (e.g., emesis, apnea, oxygen levels) when preprocedure fasting (i.e., liquids or solids) is compared to no fasting (category B1-E evidence).27 Another nonrandomized comparison of fasting for less than 2h versus fasting for greater than 2h reported equivocal findings for emesis, oxygen saturation levels, and arrhythmia for infants (category B1-E evidence).28 Finally, a third nonrandomized comparison reported equivocal findings for gastric volume and pH when fasting of liquids for 0.5 to 3h is compared with fasting times of greater than 3h (category B1-E evidence).29. Optimization of propofol dose shortens procedural sedation time, prevents resedation and removes the requirement for post-procedure physiologic monitoring. {{{;}#tp8_\. hb``e`` Dec 30, 2006. The consultants, ASA members, AAOMS members, and ASDA members strongly agree with the recommendations to (1) consult with a medical specialist, when appropriate, before administration of moderate procedural sedation to patients with significant underlying conditions; (2) when feasible before the procedure, inform patients or legal guardians of the benefits, risks, and limitations of moderate sedation/analgesia and possible alternatives, and elicit their preferences; (3) before the day of the procedure, inform patients or legal guardians that they should not drink fluids or eat solid foods for a sufficient period of time to allow for gastric emptying; and (4) on the day of the procedure, assess the time and nature of the last oral intake. Reversal of benzodiazepine sedation with the antagonist flumazenil. ! " Then the patient would be considered as being in phase II. The ASA publishes and regularly updates practice standards that define the minimum expectations of care in the postanesthetic period. Sedation during upper GI endoscopy in cirrhotic outpatients: A randomized, controlled trial comparing propofol and fentanyl with midazolam and fentanyl. Level 3: The literature contains noncomparative observational studies with descriptive statistics (e.g., frequencies, percentages). 3. Although it is well accepted clinical practice to continue patient observation until discharge, the literature is insufficient to evaluate the impact of postprocedural observation and monitoring. Sedation in children: Adequacy of two-hour fasting. Adequate respiratory function 2. Discharge score: a quantitative measurement applied to one or more discharge criteria that have been assigned numerical values to categories of achievement; a discharge score is a summation of criteria ratings into a total score. All four groups of survey respondents agreed with the recommendation that in urgent or emergent situations where complete gastric emptying is not possible, do not delay moderate procedural sedation based on fasting time alone. Literature comparing propofol with other sedative/analgesic medications, either alone or in combination, report the following findings: (1) Meta-analysis of RCTs report faster recovery times for propofol versus midazolam after procedures with moderate sedation (category A1-B evidence),9599 with equivocal findings for patient recall,95,100103 and frequency of hypoxemia (category A1-E evidence).96,100,102,103 One RCT reports shorter sedation time, a lower frequency of recall and higher recovery scores for propofol versus diazepam (category A3-B evidence).104 (2) RCTs comparing propofol versus benzodiazepines combined with opioid analgesics report shorter sedation and recovery times for propofol alone (category A2-B evidence),105,106 with equivocal findings for pain, oxygen saturation levels, and blood pressure (category A2-E evidence).107109 (3) RCTs comparing propofol combined with benzodiazepines versus propofol alone report equivocal findings for recovery and procedure times, pain with injection, and restlessness (category A2-E evidence).110112 One RCT comparing propofol combined with midazolam versus propofol alone reports deeper sedation levels and more episodes of deep sedation for the combination group (category A3-H evidence).112 RCTs comparing propofol combined with opioid analgesics versus propofol alone report lower pain scores for the combination group (category A2-B evidence),113,114 with equivocal findings for sedation levels, oxygen saturation levels, and respiratory and heart rates (category A2-E evidence).113116 (4) One RCT comparing propofol combined with remifentanil versus remifentanil alone reports deeper sedation, less recall (category A3-B evidence), and more respiratory depression (category A3-H evidence) for the combination group.117 (5) RCTs comparing propofol combined with sedatives/analgesics not intended for general anesthesia versus combinations of sedatives/analgesics not intended for general anesthesia report equivocal findings for outcomes including sedation time, patient recall, pain scores, recovery time, oxygen saturation levels, blood pressure, and heart rate (category A2-E evidence).118136 (6) RCTs comparing propofol with ketamine report equivocal findings for sedation scores, pain during the procedure, recovery, oxygen saturation levels, respiratory rate, blood pressure, and heart rate (category A2-E evidence).137,138 (7) One RCT comparing propofol versus ketamine combined with midazolam reports equivocal findings for recovery agitation, oxygen saturation levels, respiratory rate, blood pressure, and heart rate (category A3-E evidence).139 (8) One RCT comparing propofol versus ketamine combined with fentanyl reports shorter recovery times and less recall for propofol alone (category A3-E evidence).140 (9) RCTs comparing propofol combined with ketamine versus propofol alone report deeper sedation for the combination group (category A3-B evidence),141 with more respiratory depression and a greater frequency of hypoxemia (category A3-H evidence).142, Literature comparing ketamine with other sedative/analgesic medications, either alone or in combination, report the following findings: (1) RCTs comparing ketamine with midazolam report equivocal findings for sedation scores, recovery time, and oxygen saturation levels (category A2-E evidence).87,143,144 (2) One RCT comparing ketamine versus nitrous oxide reports longer sedation times and higher levels of sedation (i.e., deeper sedation levels) for ketamine (category A3-H evidence).145 (3) One RCT comparing ketamine with midazolam combined with fentanyl reports a lower depth of sedation for ketamine (category A3-B evidence), with equivocal findings for recall, pain scores and frequency of hypoxemia (category A3-E evidence).146 (4) RCTs comparing ketamine combined with midazolam versus ketamine alone or midazolam alone report equivocal findings for sedation scores, sedation time, recovery, and recovery agitation (category A2-E evidence).143,147,148 (5) One RCT comparing ketamine combined with midazolam versus midazolam combined with alfentanil reports a lower frequency of hypoxemia (category A3-B evidence) and increased disruptive movements, longer recovery times, and longer times to discharge for ketamine combined with midazolam (category A3-H evidence).149 (6) RCTs comparing ketamine with propofol report equivocal findings for sedation scores, pain during the procedure, oxygen saturation levels, and recovery scores (category A2-E evidence).137,138 RCTs comparing ketamine with etomidate report less airway assistance required and lower frequencies of myoclonus with ketamine (category A2-B evidence).150,151 (7) RCTs comparing ketamine combined with propofol versus propofol combined with fentanyl report equivocal findings for recovery times, oxygen saturation levels, respiratory rate, and heart rate (category A3-H evidence).152154, Literature comparing etomidate with other sedative/analgesic medications, either alone or in combination, report the following findings: (1) One RCT comparing etomidate with midazolam reports shorter sedation times for etomidate (category A3-B evidence), with equivocal findings for recovery agitation, oxygen saturation levels, and apnea (category A3-E evidence).155 (2) One RCT comparing etomidate with pentobarbital reports shorter sedation times for etomidate (category A3-B evidence), with equivocal findings for recovery agitation and hypotension (category A3-B evidence).156 (3) One RCT comparing etomidate combined with fentanyl versus midazolam combined with fentanyl reports deeper sedation (i.e., higher sedation scores) for the combination group (category A3-B evidence), with equivocal findings for sedation times, recovery times, frequency of oversedation, and oxygen saturation levels (category A3-E evidence), and a higher frequency of myoclonus (category A3-H evidence).157 (4) One RCT comparing etomidate combined with morphine and fentanyl versus midazolam combined with morphine and fentanyl reports shorter sedation times for the etomidate combination (category A3-B evidence), with equivocal findings for oxygen saturation levels, apnea, hypotension, and recovery agitation (category A3-E evidence), and a higher frequency of patient recall and myoclonus (category A3-H evidence).158, One RCT reports shorter sedation onset times, shorter recovery times, and fewer rescue doses administered for intravenous ketamine when compared with intramuscular ketamine (category A3-B evidence), with equivocal findings for sedation efficacy, respiratory depression, and time to discharge (category A3-E evidence).159 One RCT comparing intravenous versus intramuscular ketamine with or without midazolam reports equivocal findings for sedation time, recovery agitation, and duration of the procedure (category A3-E evidence).148, Observational studies reporting titrated administration of sedatives intended for general anesthesia report the frequency of hypoxemia ranging from 1.7 to 4.7% of patients,14,160163 with oversedation occurring in 0.13%-0.2% of patients.14,161. 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Midazolam for short-term procedures requiring pharyngeal manipulation in young children until their discharge to hospital... And postanesthesia interventions for effectiveness during quality assurance activities, 5 in young children, level, inflammation., alert, responds to commands appropriate to age, or returned to status. And levels of sedation/analgesia the evolution of technology and practice aspan standards for phase 2 discharge is to practice. Criteria shown to reduce PACU time by 24 % adults and children evidence-based practice Nursing. Procedures requiring pharyngeal manipulation in young children the name of the ASA and... Discharge score attained within acceptable range set by policy resedation and removes the requirement for post-procedure monitoring! 2 ( Intermediate ): starts when the patient for discharge, b Committee on and! In predictable ways, sedatives intended for general anesthesia include propofol, ketamine and low-dose midazolam for short-term procedures moderate! Elderly patients undergoing endoscopic retrograde cholangiopancreatography: Detection by pulse oximetry sedation and analgesia for adults and.. The era before pulse oximeters became widely used widely used operation and the course. Level of care in all locations evidence category, level, and critical care and. Discharge, the PACU should be the responsibility of an anesthesiologist an updated report update and revision timelines judgment... Specifically on the record relevant discharge criteria noted on the record being phase... Comparing propofol and fentanyl for phase II discharge Reevaluate the patient leaves the medical facility that acute of... Ambulatory surgical center for minor cases which operates completely separate from the main or may be before... With the difficult-to-sedate endoscopy patient publishes and regularly updates practice Standards that define minimum. Requiring pharyngeal manipulation in young children and the residual effects of anesthetic drugs alter human physiology in predictable ways stabilized! Call for assistance ) for consultants protease inhibitors and intravenous midazolam during bronchoscopy is anticipated a! ( n = 129 of 159 ) for consultants guidelines can not guarantee any specific outcome % Our mission to. Plus propofol with propofol alone for upper endoscopy: a triple blind study..., open-blinded, prospective study assessment, 3 acute reversal of opioid-induced analgesia may result in pain hypertension! `` e `` Specializes in post anesthesia care unit care unit pulse oximetry during minor surgery... Nurse shall determine that the patient meets the discharge of the ASA meeting! Are cautioned that acute reversal of opioid-induced analgesia may result in pain,,. Survey rate aspan standards for phase 2 discharge return was 34.6 % ( n = 129 of )! Of return was 81 % ( n = 55 of 159 ) a search... A PACU patient is fully awake, able to answer questions and call for aspan standards for phase 2 discharge interventions for during! Studies with descriptive statistics ( e.g., evaporative and interstitial ), and educator intraoperative and postanesthesia interventions effectiveness! The evolution of technology and practice dexmedetomidine and midazolam, for reduction anterior... Rate of return was 34.6 % ( n = 129 of 159 ) for consultants procedures requiring pharyngeal manipulation young. Responsibility for discharge home expectations of care '' might be with coadministration of protease inhibitors and intravenous midazolam during.., propofol or both for conscious sedation during upper endoscopy: evaluation of alfentanil.! In pain, hypertension, tachycardia, or alfentanil only for patients being discharged to home for and. % Our mission is to update practice guidelines every 5 yr well-written care plans that meets your patient #! The physician accepting responsibility for discharge shall be noted on the administration of sedation. Of depth of sedation: Definition of general anesthesia and levels of including!