MODERATE SEDATION

Moderate Sedation: A depressed level of

consciousness that carries the risk of losing
protective reflexes.
Sedation Criteria Includes:

 ability to retain protective airway reflexes

 ability to independently and continuously
maintain a patent airway
 ability to respond appropriately to both
physical and verbal stimuli
Objectives of Moderate/Conscious Sedation
1. Use the least amount of sedation to provide pt. comfort
2. Maintain adequate sedation with minimal risk
3. Relieve anxiety and produce amnesia
4. Provide relief of pain and other noxious stimuli
5. Enhance patient cooperation
6. Maintain stable vital signs
7. Ensure a rapid recovery
Levels of Sedation
1. Minimal sedation = anxiolysis (removal of anxiety)
 A drug-induced state which patients respond normally to verbal
commands
 Although cognitive function and coordination may be impaired,
ventilatory and cardiovascular functions are unaffected.

2. Moderate sedation/analgesia (Conscious Sedation)

 Patients respond purposefully to verbal commands, either alone or
accompanied by light, tactile stimulation.
 No interventions are required to maintain a patent airway, and
spontaneous ventilation is adequate
 Cardiovascular function is usually maintained.
Levels of Sedation cont.
3. Deep Sedation/analgesia
 Patients cannot be easily aroused, but respond purposefully following
repeated or painful stimulation
 The ability to independently maintain ventilatory function may be
impaired.
 Patients may require assistance in maintaining a patent airway and
spontaneous ventilation may be inadequate.
 Cardiovascular function is usually maintained.
Levels of Sedation Cont.
4. Anesthesia
 Consists of general anesthesia and spinal or major regional anesthesia
 General anesthesia is a drug-induced loss of consciousness during
which patients are not arousable, even by painful stimulation
 The ability to independently maintain ventilatory is impaired
 Positive pressure ventilation may be required because of depressed
spontaneous ventilation or drug-induced depression of
neuromuscular function
 Cardiovascular function may be impaired
 Moderate Versus Deep Sedation
Moderate Deep Sedation
 Mood altered.  Cognitive function impaired
 Purposeful response to verbal  Patients cannot be easily aroused
commands  Respond purposefully following
accompanied by repeated or painful
 Respond to verbal commands stimulation
alone or with light tactile  Not awake enough to follow verbal
stimulation commands
 Patient cooperative  Ability to maintain own airway
 Can maintain own airway  Ventilatory function may be impaired
 Spontaneous ventilation is  Cardiovascular function is usually ok
 VS may be labile
adequate
 VS stable
Indications for Sedation
1. Diagnostic procedures (angiogram, endoscopy, biopsy)

2. Minor Surgery (skin closure/excision)

3. Potentially painful procedures (chest tube insertion or

fracture reduction)

4. Decrease anxiety before procedures and diagnositc

tests (MRI)
Who can administer Moderate Sedation

Only qualified staff may

administer moderate sedation
under the guidance and order
of a credentialed physician on
the facility’s medical staff.
Assessment
Pre Procedure Assessment
Physcian:
1. The physician reviews with the patient, parent,
guardian:
 The risks, options, and benefits of the selected
medications and procedure.
 Obtains informed consent, which is kept in the
patient’s medical record.(the nurse may witness the
signature on the consent)
 Writes order on chart for medications to be given for
the procedure.
Physician Admission Assessment
An admission assessment will be completed pre-
procedure. The physician’s assessment should include
documentation of, but not limited to, the following
 ASA Classification Status

 Mallampati Scale

 Appropriateness of moderate sedation for the patient

American Society of Anesthesiology / ASA
Classification
A.S.A. Class 1: No organic, physiologic, biochemical, or psychiatric
disturbance.
 The pathologic process for which the operation is to be performed is localized
and does not entail a systemic disturbance.
A.S.A. Class 2: Mild to moderate systemic disease disturbance cause either
by the condition to be treated surgically or by other pathologic processes:
 well-controlled hypertension; and no postural hypertension
 history of asthma, no wheezing on day of procedure
 anemia; Hct greater or equal to 30 gm
 cigarette use; without COPD problems
 well-controlled diabetes mellitus;
 mild obesity; 20% above ideal body weight (IBW)
 age <1 year or >70 years; and pregnancy.
ASA Level Cont.
A.S.A Class 3: Severe systemic disturbance of disease from whatever cause,
even though it may not be possible to define the degree of disability with
finality:
 angina;
 status post-myocardial infarction; less than 3 months ago
 poorly controlled hypertension;
 symptomatic respiratory disease (e.g., asthma, COPD); and
 massive obesity, greater than 50 pounds or 30% of IBW)
A.S.A. Class 4: Indicative of the patient with severe systemic disorders that
are already life threatening, not always correctable by operation:
 unstable angina, unrelieved by Nitroglycerin and rest
 congestive heart failure;
 debilitating respiratory disease; and
 hepatorenal failure.
ASA Level Cont.
 A patient classified as ASA 1 and 2 will be sedated and
monitored by RN staff.
 A patient classified as ASA 3 and 4 may be sedated and
monitored by an RN under the direct supervision of an
anesthesiologist or a physician credentialed to give IV
conscious sedation.
Mallampati System
The Mallampati system anticipates the degree of
difficulty of endotracheal intubation from I to IV,
by relating tongue size to pharyngeal size. Patient is
examined in the sitting position, with head in neutral
position and mouth open 50-60mm (2-21/2 inches)
and the tongue protruding to the maximum.
Mallampati System Cont.
Characteristics of Potential Difficult Airway
The following physical characteristics may indicate the
potential for difficult airway management:
 Hyponathic jaw (recessed)
 Hypernathic jaw (protruding)
 Deviated trachea
 Large tongue
 Short thick neck
 Protruding teeth
 High arched palate
Pre-procedure Assessment
Nurses:
An admission assessment will be completed pre-procedure.
The assessment will include documentation of, but not
limited to, the following:
a) allergies/sensitivities;
b) current medications;
c) baseline vital signs and weight;
d) IV site and patency;
e) Concurrent medical problems;
f) Level of consciousness.
Pre-procedure Assessment Cont.
Physical baseline assessment parameters include all
the above and:
 Anxiety level
 Vital signs include temperature
 Skin color and condition
 Sensory defects
 Relevant medical and surgical history, including
substance abuse
 Patient perceptions regarding procedure and moderate
sedation
Nurse Cont.
 Ask if they have ever had a bad experience in surgery or dentist
office – problem with the sedation or to the local?
 Identify current medications - check for contraindications i.e. you
don't want to give narcotics when your patient is taking MAO
Inhibitors, or if asthmatic avoid Fentanyl.
 Obtain weight - precalculate dosages for sedatives and reversal
agents
 Medical Condition unrelated to this procedure – is it well controlled?
 What is patient’s perception of their pain tolerance ? i.e. use scale 1-10
to establish baseline pain level
 NPO status (Remember that emergency patients given sedation are at
high risk for aspiration.)
Nurses Cont.
Patient Education:
 Concurrence with pre-arrangements for safe transportation including
discharge to the care of a responsible adult. The patient may not drive
theirself home.
 Educate the patient what to expect during the procedure, and the
continuous monitoring.
 Demonstrate what correct "deep breathing" looks like.
 Instruct the patient in the use of a pain scale (e.g. 1-10 pain scale)
 Provide discharge instructions prior to the procedure whenever
possible; postsedation the patient may not remember everything that is
said to them.
 Ensure emergency equipment, medications, and supplies are
immediately available.
Equipment Needs
Emergency equipment, including a defibrillator, must
be immediately accessible to every location where
conscious sedation is administered. The equipment
should include, but not be limited to the following:
 emergency, resuscitation, and antagonist drugs;
 airway and ventilator adjunct equipment for adult and
pediatric patients;
 defibrillator;
 source for administration of 100% oxygen and
 capability for suctioning of the patient.
Patient Assessment
Cardiovascular status - HR, BP
 Goal: Back to patient’s baseline or within +/- 20% of
patient’s baseline.
Respiratory status - Oxygen saturation, respiratory
rate, pattern
 Goal: > 94% on room air or back to patient’s baseline levels
Level of Consciousness
 Goal: Alert/awake or at baseline
Neurological/Activity
 Goal: Back to baseline
Patient Assessment Cont.
Pain Assessment:
 Goal: < 4 or back to baseline (use 1-10 pain scale; 1= minimal)
GI assessment:
 Goal: No Nausea or Vomiting
Protective Reflexes include -
 Subconscious abilities of a person to swallow secretions and
prevent foreign bodies (emesis) from entering the lungs via
aspiration or coughing,
 Eyes blink
 Extremities move purposefully
 Speaking with minimal slurring.
Intraprocedural Assessment
 The patient will be connected to all monitors upon
arrival in the procedure area. Monitor connections will
be reassessed following any position changes before or
during the procedure.
 All monitor alarms will be active and audible
throughout the procedure.
 All patients with an SaO2 < a certain level (e.g. 94%)
will receive supplemental nasal cannula oxygen as
ordered by the physician.
Intraprocedural Assessment
 All patients receiving conscious sedation will be continually monitored for physiological
changes. Monitoring will be documented every 5 minutes or at each significant event on
the appropriate monitoring record for each area. This monitoring procedure may include,
but is not limited to, the following:

1. monitoring devices or equipment used;

2. physiological data from continuous monitoring (cardiac rate and rhythm, oxygen

saturation, respiratory rate, blood pressure);

3. level of consciousness;

4. dosage, route, time and effects of all drugs or agents used;

5. type and amount of fluids administered;

6. any untoward or significant patient reaction and its resolution; and

7. skin condition and color (warm cool, pink, pale, cyanotic).

Medications
Medications
*Each and Every patient under going Moderate Sedation
must have IV Access.
The medications used for moderate sedation are chosen
with consideration to:
 Action
 Length of action
 Bioavailability
!!! Be careful with how fast you give drugs IV push.
Some medications can cause serious side effects if given
too rapidly.
Benzodiazepines
 Midazolam (Versed)
 Diazepam (Valium)
1. Produce sedation, relief of anxiety, antegrade amnesia, and some skeletal
muscle relaxation– but not pain relief
2. Synergistic (additive) effect when given with narcotics
3. Use with caution in patients with:
 a history of COPD,
 sleep apnea,
 known cardiovascular depression,
 intoxicated patients,
 patients with liver or renal disease,
 difficult airways, and in the
 very young and the
 very old
Benzodiazepines Cont.
Antagonist = Flumazenil (Romazicon)

Age-Related Considerations:
 In the elderly patient reduce the loading dose by 40-50%
 Avoid use in pregnancy –crosses placental barrier and is in breast milk

Watch for symptomatic bradycardia if your patient is on:

Lopressor (metoprolol) or Inderal (propanolol) or Digoxin (digitalis)

Increase effect of action for patients on:

 CNS depressants Skeletal muscle relaxants
 MAO inhibitors/tricyclic antidepressants
 Antiarrhythmics (e.g. lidocaine)
 Concurrent sedatives/narcotics Alcohol
 Antipsychotics Phenothiazines/antihistamines
Benzodiazepines Cont.
Diazepam (Valium):
 Minimal effect on ventilation and circulation
 Long acting
When given IV:
 Rate for IVP = 5 mg/minute
 Onset = 1-3 minutes
 Peak effect in 3-4 minutes
 Duration = 15-30 minutes
Interaction / Toxicity:
 Don't give IM
 Bradycardia, hypotension, respiratory depression, drowsiness, ataxia,
confusion, depression, venous thrombosis/phlebitis at injection site
 Return of drowsiness may occur in 6-8 hours after dose
 Do not mix or dilute with other solutions / drugs
Benzodiazepines Cont.
Midazolam HCL (Versed):
 Short acting, with sedative and skeletal muscle relaxing properties
 Compared with Diazepam (Valium) – it is more rapid onset, shorter duration,
greater amnesic effect, and 3-4 times as potent .
If given IV:
 Rate if given IVP = 1 mg/minute; Give slow IVP, never rapid as IV bolus – respiratory
depression &/or arrest may result from excessive dosing
 Onset = 1-5 minutes
 Peak = 3-5 minutes
 Duration = 30-40 minutes; up to 2-4 hours
Interactions/Toxicity:
 Tachycardia, PVC, hypotension, broncho/laryngospasm, apnea, tonic-clonic motion
 Reduce dose in elderly, hypovolemic, and COPD
 Contraindicated in glaucoma unless patient is being treated for it
Narcotics (Opioids)
 Morphine Sulfate (MS)
 Meperidine (Demerol)
 Fentanyl (Sublimaze)
 Analgesia (pain relief ) properties are the best of
any drug
 Profound effect on the cardiovascular system
 Morphine and Demerol effect the respiratory
system leading to bronchoconstriction, decreased
respiratory rate and volume
Narcotics (Opioids) Cont.
Agonist = Naloxone (Narcan)

Age-Related Considerations:
 Elderly patients usually require reduced dose
 Narcotics cross the placental barrier and are secreted in breast milk

Increased effects of narcotics are seen with:

 CNS depressants
 Skeletal muscle relaxants
 MAO inhibitors
 Cimitidine (Tagamet)
 Concurrent sedatives Alcohol
 Antipsychotics Phenothiazines/antihistamines
Narcotics (Opioids) Cont.
Demerol (Meperidine) :
 All narcotics but Demerol (meperidine) produce bradycardia
(Demerol produces tachycardia secondary to its vagolytic effect);
use with caution if liver or renal disease, or MAO inhibitor use.
 Slightly less potent then Morphine; however half-life = 15-30 hours
 May give postoperatively to decrease shivering.
If given IV:
 IV inject rate = 25 mg/minute; may cause vomiting if given too
rapidly.
 Onset = 5-10 minutes
 Peak : 15 minutes
 Duration = 2-3 hours
Narcotics (Opioids) Cont.
Fentanyl (Sublimaze):
 As analgesia, Fentanyl is 75-125 times more potent than Morphine (e.g. 100
micrograms of Fentanyl = 10 milligrams of morphine)
 Incompatible in IV tubing with Valium (remember - nothing goes with
Valium)
If given IV:
 IV Inject rate = 50 mcg/minute; if given too rapidly may get “wooden
chest”; chest wall muscles become tight; treat by ventilating with an Ambu-bag
and a muscle relaxant (i.e. succinycholine)
 Onset within 30 seconds
 Peak effect = 5-15 minutes
 Duration = 30-60 minutes
 Interaction/Toxicity:
 Analgesia enhanced and prolonged by epinephrine and clonidine
Narcotics (Opioids) Cont.
Morphine (MS) :
 Morphine is inexpensive
 Side effects markedly increased if rate of injection too rapid (i.e.
respiratory depression)
 Pain relief is almost immediate and lasts up to 4-5 hours (average 2
hours)
Incompatible in IV tubing with Demerol and other meds.
If given IV:
 IV inject rate = 2-5 mg/minute
 Onset = 1-3 minutes
 Peak: 20 minutes
 Duration = 4 hours
Reversal Medications
Naloxone (Narcan)
Flumazenil (Romazicon)
 Give in small doses to reverse deep sedation and respiratory
depression.
 Some physicians order a reversal agent to rapidly reverse the
effects of sedation.
 Reversal medications length of action is shorter than the length
of the drug reversed, so repeat dosing of the reversal drug may be
necessary.
 If a patient receives a reversal agent, that patient should be
monitored for 2 hours prior to discharge, and then only
discharge if they meet discharge criteria.
Reversal Medications Cont.
Naloxone (Narcan)
Narcotic antagonist, reverses respiratory depression and analgesia
due to opioids.
 May be given IV push, IM or Subcutaneous injection – for injections
if using dilution (shown below) then administer in divided doses.
 Onset: IV = 2-3 min. IM = 15 min. Subcutaneous = 15 min.
Dilute 0.4mg/ml Narcan with 9 ml injectable normal saline
(= 0.04mg Narcan/ml or 40mcg/ml)
This dose works for all pediatric patients over 4kg (8.8 pounds):
 Pediatric IV, IM, Subcutaneous dose: 0.01mg/kg every 2-3 minutes
 Adult IV, IM, Subcutaneous dose: 40 mcg or 1ml every minute, not to
exceed 0.1-0.2 mg every 2-3 minutes
Reversal Medications Cont.
Narcan cont.
Onset: 1 –2 min. Peak: 5-15 minutes Lasts: 45 min. – 4 hours
Often does not last as long as opioid and therefore may need to
repeat dose.
Adverse effects: Reverses analgesia (pain control)
Titrate to effect – if given rapidly can produce non-cardiogenic
pulmonary edema tremors, excitement, seizures,
hyperventilation, pulmonary edema (non-cardiogenic),
hypotension, bradycardia, ventricular tachycardia/fibrillation,
nausea/vomiting
Contraindications: Patients with a history of hypersensitivity
to the drug.
Reversal Medications Cont.
Romazicon (flumazenil)
Pediatric (age 1 to 17 yrs.) IV dose: 0.005-0.01 mg/kg every 2-3 minutes based on
response; Maximum dose for reversal of moderate sedation is 0.2 mg.
Adult IV dose: 0.003 mg /kg every 1-2 minutes as needed; Maximum dose for reversal of
moderate sedation is 0.2 mg
Use free flowing IV.
May repeat in 2-3 minute intervals in doses of 0.2 mg up to desired level of consciousness.
Do not exceed total dose of 3 mg/hr without response.
Onset: 1-2 min. Peak: 6 – 10 min. Lasts: 1- 2 hours
80% of the response within the first 3 minutes; no response in 5 min. look for another cause.
Adverse effects: dizziness, headache, agitation, seizures, dyspnea, sweating, palpitations,
dysrhythmias, hypertension, chest pain, nausea/vomiting, pain at injection site.
Contraindications: Hypersensitivity to flumazenil or benzodiazepines – can precipitate
withdrawal or seizure activity. May provoke panic attack in patient with history of panic
disorder, unknown coma, physical dependence on benzodiazepines.
Local Anesthetics
Lidocaine 0.5-2 30-120 120-360 300 500
(Xylocaine) Rapid Moderate

Bupivicaine 0.25-0.5 120-240 180-420 175 225

(Marcaine) Slow High High

(Note: 2% concentration is more potent than the 1% )

Local Anesthetics Cont.
Progressive Signs of Toxicity – LOCAL Anesthetics:
1. Metal taste in mouth
2. Tinnitus – “ringing in the ears”
3. Peri-oral numbness/tingling – “lips are numb”
4. Change in sensation – talk nonsense, euphoria
5. Seizure
6. Respiratory Arrest or
7. Cardiac Arrest
Local Anesthetics Cont.
Toxicity Treatment:
 Remember CPR “A-B-Cs”
 Oxygen – support respiration with AMBU bag
 Ventilator
 Seizure – give Valium, Versed, Diprivan (Propofol)
 ACLS protocols are followed for cardiac arrest
AIRWAY
Agitation
Some patients will become agitated during
Moderate/Conscious Sedation and you will want to rule out
the cause.
The top 4 (four) causes are:
1. Hypoxia (oversedation) - < 94% oxygen saturation
2. Inadequate Analgesia – remember to time the
administration of the medication to
achieve peak effect during the procedure.
3. Inadequate Sedation – titrate slowly to patient response,
never bolus
4. Paradoxical Reaction – rare
Airway Management
Recognizing a patient who has an inadequate airway:
 Change in breathing (snoring, loss of snoring)
 Decreased oxygen saturation
 Loss of chest expansion
 Rocking of the chest and abdomen
 Changes in heart rate or blood pressure
 Changes in mental status; increased difficulty in arousing, agitation
 Changes in skin color from pink to pale or dusky – a late sign of hypoxemia
 Changes in head position
 Any sign of a change in the patient’s general status should initiate an
 inspection of respiratory status -- restlessness and agitation are always
 considered signs of hypoxia or if not that then inadequate analgesia.
Airway Management Cont.
Hypoxemia is…
 generally a late sign of hypoventilation or airway obstruction
 Remember gradual hypoxemia may not produce any signs or
symptoms
Intervene for your patient:
1.) Ask your patient how they are doing, if they respond and
deny any respiratory problems, then one can be reasonably
certain that the airway is patent.
2.) If a patient does not respond, then gentle stimulation
should be tried such as shaking a shoulder and using a
louder voice.
Airway Management Cont.
3.) If a patient has not yet responded try moving the patients
tongue off the back of their throat by first:
 turning head laterally, then
 head-tilt / chin-lift, then a
 jaw-thrust maneuver will also serve to stimulate the
patient to breathe because it is somewhat painful when
used. The jaw thrust = use of both hands behind the ramus
of the mandible to move the mandible forward to lift the
tongue off the back of the throat to open the airway. Be
aware that the facial nerve runs behind the ramus of the
mandible and damage to it can result in facial palsy.
Airway Management Cont.
Nasal Airway - First try to insert a nasal airway because nasal are better
tolerated than oral airways if your patient is not unconscious.
 Measure for length from the tip of the nares to the lobe of the ear.
 Lubricate the tube first with KY jelly (or any water-soluble jelly),
and insert in the nostril staying close to the midline until it sets
behind the tongue.
 Slight rotation of the tube may help you angle it through as
needed. Gentle pressure not force may be used. If excessive pressure is
encountered on placement of the airway, withdraw and attempt to place it
on the other side.
 Check lung sounds immediately after putting it in.
 RISK: Epistaxis down the back of the throat may stimulate laryngospasm or
bronchospasm
Airway Management Cont.
Orophyaryngeal (oral) Airway may work safest for
unconscious patients because it may stimulate vomiting.
1) Measure from corner of mouth to tip of ear to estimate
length.
2) Suction before insertion if possible.
3) Insert with curve up as it enters the mouth, as you reach
the back of the throat …
4) …rotate it so it curves down the throat or use a tongue
depressor and insert the airway curve down.
5) Listen to lung sounds after insertion.
Airway Management Cont.
 Oral airway risks = may stimulate vomiting, cause
bradycardia due to vagal stimulation, retching leading
to hypertension and tachycardia, laryngospasm, dental
damage, and lip lacerations - also ensure that lips or
tongue are not trapped between teeth.
Airway Management Cont.
Ambu-bag = positive pressure ventilation bag-valve-
mask device
Ambu-bags usually need 10-15 liters of oxygen to
provide 100% oxygen.
If your patient is breathing:
 inefficiently, but not completely apneic, then
synchronize your bagging with the patient's
inspiration effort.
 not at all on their own, bag at a rate of 16-20 breaths a
minute or every 3-5 seconds.
Airway Management Cont.
If basic airway maneuvers fail to provide a patent airway
with adequate air exchange or if the patient has
limited respiratory efforts, the physician supervising
the procedure should
 consider administering reversal agents
 Prepare for intubation with an endotracheal tube.
Airway Management Cont.
Supplemental Oxygen:
Nasal Cannula: 1-6 L/minute = 24 - 44 % for patient with
normal tidal volume
 1 L = 24% 3 L = 32% 5 L = 40%
 2 L = 28% 4 L = 36% 6 L = 44%
Face Mask: 8-10 L = 40 - 60%, the flow should be >5 L /
minute to avoid rebreathing exhaled air held inside the mask.
Ambu-bag: 15 L = up to 100%, use basic airway head
positioning and oropharyngeal airway if possible. Hold mask
to patients face and squeeze the bag. Watch for gastric
distention.
Postprocedural
Complications
Postprocedure Complications
Pain
 Postprocedure pain
 Pain from chronic condition(arthritis, etc.)
Treatment Options
 Acetaminophen
 NSAIDs
 Prescribed opiates
Postprocedure Complications
Nausea and Vomiting
 Increased vagal tone
 Hypotension
 Pain
 Opiate administration
 Hypoglycemia from NPO status
Treatment Options
 Liberal IV fluid replacement
 Phenergan (Promethazine)
 Zofran (Ondansetron)
 Compazine
Postprocedure Complications
Airway obstruction
 Tongue against posterior pharynx
 Secretions
 Vomit
 Blood
Treatment Options
 Verbal / physical stimulation
 Head tilt
 Chin Lift
 Jaw Thrust
 Nasal / Oral Airway
 Intubation
Postprocedure Complications
Hypoventilation
 Residual sedative effects
 Preexisting pulmonary disease
 Inadequate reversal
 Overdose
Treatment Options
 Verbal / physical stimulation
 Continue giving oxygen
 Encourage deep breathing
 Give additional reversal agent
 Assisted ventilation
 If not breathing - intubate
Postprocedure Complications
Hypotension
 Enhanced vagal tone Left ventricular dysfunction Hypovolemia
 Pain
 Hemorrhage
Treatment Options
 Reduce factors that stimulate Vagal tone (pain, anxiety, agitation,
etc.)
 Correct factors that impair left ventricular performance (myocardial
ischemia, fluid overload, etc.)
 IV fluids
 Pain relief
 Ephedrine, Trendelenburg
Postprocedure Complications
Hypertension
 Neuroendocrine response to procedural pain Hypoxemia
 Hypercapnia
 Preexisting hypertension
Treatment Options
 Relieve pain
 Relieve noxious stimuli (full Bladder distention bladder)
 Fix respiratory obstruction
 Give beta / alpha blockers
Discharge
Criteria for Discharge
1. All parameters normal or back to patient’s baseline.
2. Physician MUST give a discharge order
3. Oxygen saturation > 94% on room air or equal to
patient’s pre-sedation state
4. Adult patients must be able to ambulate
independently (or at baseline) - except for patients
whose procedure changes their ability to ambulate.
5. Infant and toddler patients must be able to sit up
independently or walk as is appropriate for age.
Criteria for Discharge
6. The patient should have no more than minimal/manageable
discomfort
7. REACT Score discharge score = pre-procedure status or
higher; (if score is less than 7)
8. Stability of vital signs, including temperature.
9. Pre-procedure level of consciousness
10. Intact protective reflexes, including a gag reflex
11. Ability to retain oral fluid, as appropriate to physician orders
12. Ability of patient and home care provider to understand
home care instructions
Discharge Instructions
 Written discharge instructions will be given to all patients:
 Telephone number patient can call for assistance if needed
 Tell them the name of the sedating drug used
 Instructions to NOT drive a motor vehicle or operate any dangerous
machinery for
 24 hours or longer if taking pain or sedating medication
 Do NOT drink any alcohol for 24 hours
 Diet Instructions
 Wound care / Dressing changes
 Explain follow up phone calls or surveys that the patient might get
 If medications are given - the purpose, dose, route, frequency,
duration of use, and side effects if any should be explained
The End