Sedation is a continuum. During a procedure, a patient can slip into a deeper level of sedation than intended.([FOOTNOTE=Patel S, Vargo J, Khandwala F. et al. Deep sedation occurs frequently during elective endoscopy with meperidine and midazolam. Am J Gastroenterol. 2005;100:2689–2695.],[ANCHOR=],[LINK=])
Careful monitoring of each patient is important to help ensure they do not become oversedated – and that complications are detected early.
In older patients who undergo procedures outside versus inside the OR.1
Age and comorbidities are key factors clinicians consider in providing sedation.2
It is not always possible to predict a patient’s response.([FOOTNOTE=American Society of Anesthesiologists. Continuum of Depth of Sedation: Definition of General Anesthesia and Levels of Sedation/Analgesia. 2016. Accessed March 8, 2017.],[ANCHOR=View Abstract],[LINK=http://www.asahq.org/~/media/Sites/ASAHQ/Files/Public/Resources/standards-guidelines/continuum-of-depth-of-sedation-definition-of-general-anesthesia-and-levels-of-sedation-analgesia.pdf])
Age, metabolism, personal history, and even genetics may all play a role in a patient’s response to sedation. 5,([FOOTNOTE=Borrat X, Trocóniz IF, Valencia JF, et al. Modeling the influence of the A118G polymorphism in the OPRM1 gene and of noxious stimulation on the synergistic relation between propofol and remifentanil: sedation and analgesia in endoscopic procedures. Anesthesiology. 2013 Jun;118(6):1395-407.],[ANCHOR=],[LINK=])