Clinical and safety considerations for moderate and deep sedation

The need for anesthesia services is increasing both in and out of the operating room. Ideally, individuals with the most training and experience with sedation would administer it. Due to the high volume of cases that require sedation, however, many non-anesthesiologists are providing this service. It is important for sedation providers to realize there are several different levels of sedation, but that clinically it may be difficult to differentiate among them. Sedation providers must demonstrate sufficient knowledge regarding the preprocedural evaluation, the necessary monitors and equipment availability, the commonly administered medications and their reversal agents, and when a patient has recovered from sedation and can appropriately be discharged. Each institution offering sedation services must follow the federal and state regulations on moderate and deep sedation, and sedation providers must have the appropriate qualifications. The specific education and training required of sedation providers differs among institutions. Although most institutions adopt the guidelines and standards of the American Society of Anesthesiologists, each professional society also has its own set of guidelines. In the end, whether sedation is administered by anesthesia or non-anesthesia providers, patient safety is of utmost concern.