Getting Sedation Just Right Is

Part Art. Part Science. All Heart.

See how clinicians at the University of Miami Health System make decisions about sedation.

Avoiding Sedation

26% of patients became deeply sedated when moderate sedation was intended.([FOOTNOTE=Saunders R, Erslon M, Vargo J. Modeling the costs and benefits of capnography monitoring during procedural sedation for gastrointestinal endoscopy. Endosc Int Open. 2016;4(3):E340-E351.],[ANCHOR=],[LINK=])

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.

More Comorbidities

3.5 years older mean age of patient in procedural sedation cases vs. OR.

In older patients who undergo procedures outside versus inside the OR.1

Age and comorbidities are key factors clinicians consider in providing sedation.2

Managing Different Responses to Sedation

30% decrease in drug elimination in elderly patients.([FOOTNOTE=Klotz U. Pharmacokinetics and drug metabolism in the elderly. Drug Metabolism Reviews. 2009;  41:2, 67-76.],[ANCHOR=],[LINK=])

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=])