PROCEDURAL SEDATION FOR DIAGNOSTIC AND THERAPEUTIC PROCEDURES OUTSIDE THE OPERATING THEATER

WHAT IS SEDATION?

Sedation means the administration of drugs to relieve anxiety and pain, and is the fastest growing area in anesthesia care. The aim of sedation is to make the patient comfortable and safe during a procedure. The patients become drowsy, sleepy, many of them sleep, they have no pain, and they remember very little about the operation.Communication is possible if needs to be during the operation.

To make a patient comfortable we administer drugs; to make a patient safe we monitor the patient as if the patient will get a general anesthesia. Certain procedures e.g. endoscopies, plastic surgery, dermatology, dental and other medical procedures can now be safely done outside the operating theater. This has very important implications for costs, as sedation care involves lower costs than theater and anesthesia care. Many patients have had previous posttraumatic experiences and are extremely anxious when in a theater environment. Sedation can be safely done outside the theater in adequately equipped rooms.

Recovery after sedation is much faster than with general anesthesia. The same applies for the side effect profile e.g. nausea and vomiting which is much less than with general anesthesia. In fact very few patients experience any side effects. Medical insurance is becoming very interested in sedation as an option in patient care.

Patient satisfaction is very high after sedation. A recent survey of the experiences and satisfaction of patients show that 99.5% of patients would take sedation again if they have a choice. Sedation practice is carefully controlled. It is expected that practitioners must have had training in the administration of sedation. The South African Society of Anesthesiologists drafted guidelines for sedation practitioners in 2010.

Sedation has become a viable alternative for general anesthesia for certain procedures and can be administered to both adults and children.

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FREQUENTLY ASKED QUESTIONS

How does sedation differ from general anesthesia?

With sedation the patient is not unconscious. The patient feels comfortable and relaxed, free from anxiety and pain, but can even sleep. Patients can be roused by verbal communication or light stimuli if need to be. Sedation can also be done outside the operating theater. With general anesthesia the patient is unconscious and cannot be communicated with. General anesthesia can only be done inside a hospital in an operating theater.

If I am aware during the operation, will I be uncomfortable and feel any pain?

The patient will feel no pain. The aim of sedation is to control anxiety and pain. The sedation practitioner will administer drugs so that the patient is comfortable and free of pain. The drugs will also contribute towards a pain free period after the operation.

How long does it take to recover after the operation and how soon can I go home?

Because sedation is done outside the operating theater recovery is very quick. However patients may differ in their responses to drugs. Recovery time is usually about 30 minutes. The sedation practitioner will carefully monitor the patient as to fitness for discharge. Patients maybe drowsy for a few hours and are given specific written and verbal instructions what to do.

What side effects can one get after sedation?

The usual side effects after general anesthesia include nausea and vomiting, pain, headaches, sore throat, shivering and drowsiness. The incidence of nausea and vomiting after sedation is significantly lower than after general anesthesia, as are all the above side effects mentioned.

How should I spend my time at home after the operation?

All patients receive written instructions what they are allowed to do. Before the sedation the sedation practitioner will also give details to the patient. What is important is that the patient is not allowed to drive for the rest of the day. There must also be a responsible adult person that can accompany the patient home.

Will my medical aid pay for the sedation?

There are already medical aids paying for sedation services. Patients should contact their medical aid before the operation to get authorization. Medical insurance is increasingly interested in sedation services as it is cost effective and safe. Some of them have already said that they will support sedation training.

Who is qualified to provide sedation services?

The South African Society of Anesthesiologists drafted guidelines for sedation practitioners for sedation of adults and children in 2010. The guidelines give a comprehensive outline how sedation can be safely done. It is clear that sedation can only be done by those trained how to administer the sedation, and monitor the patient. It is expected that a sedation practitioner must have a postgraduate qualification in sedation.

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Professor James Roelofse

Emailjaroelofse@uwc.ac.za

MB ChB M

Med (Anaes)

PhD (Anaes)

Diplomate of the National Dental Board of Anesthesiologists (USA)

Professor Roelofse has been actively involved in all matters concerning sedation for most of his professional career. He is the architect of the Postgraduate Diploma in Sedation and Pain Control presented at the University of the Western Cape, Cape Town (previously presented it at Stellenbosch University), and the Postgraduate Certificate in Sedation and Pain Management presented at University College London, London UK.

He also offers a Masters research degree in Sedation and Pain Control at the University of the Western Cape. He wrote a Masters program in Sedation and Pain Management for University College London, which was approved by the University covering both basic/standard and advanced sedation techniques.

He is currently Head of Sedation and Pain Control at the University of the Western Cape, and was appointed Visiting Professor in Anesthesiology in 2004 at University College London where he is still the director of the Postgraduate Certificate in Sedation and Pain Management. Sedation training was also initiated in Africa where he was appointed as a Visiting Professor in Anesthesiology at the Aga Khan University in Nairobi, Kenya. Various African countries have approached him with the view of sedation training in 2011.

Apart from his academic and teaching commitments, he remains a practicing sedation practitioner. Professor Roelofse is the author/co-author of 150 refereed scientific articles. He is currently,

  • President of the Society of Sedation Practitioners of South Africa (SOSPOSA) which is a special interest group of the Society of Anesthesiologists (SASA)
  • Member of the Executive Pediatric Committee on sedation at WorldSiva (Society for Intravenous Anesthesia)
  • Member of the Patient Safety Committee of WorldSiva
  • Member of the International Sedation Task Force (ISTF)

He is a member of both committees who drafted the adult and pediatric guidelines on Procedural Sedation and Analgesia for SASA.

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