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Chapter 11 - Respiratory Compromise in Moderate and Deep Sedation

Published online by Cambridge University Press:  12 December 2024

By
Ashish K. Khanna  and
Fredrik Olsen
Edited by
Richard D. Urman  and
Alan David Kaye
Richard D. Urman
Affiliation:
Ohio State University
Alan David Kaye
Affiliation:
Louisiana State University School of Medicine
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Summary

Sedation and anesthesia are common triggers of respiratory compromise, which often manifests as depression of respiratory drive, airway occlusion, and resultant hypoxemia and hypercarbia. The respiratory compromise cascade (Figure 11.1) can be understood as a set of states through which a patient moves from respiratory insufficiency toward respiratory failure and, ultimately, respiratory arrest. While the movement of a patient through the cascade is not linear, the effect of increasing momentum with progression to each phase occurs. Therefore, the later the patient is recognized in the cascade, the more serious the interventions to restore normal gas exchange become.

Type
Chapter
Information
Moderate and Deep Sedation in Clinical Practice , pp. 143 - 151
Publisher: Cambridge University Press
Print publication year: 2024

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References

Cook, T, MacDougall-Davis, S. Complications and failure of airway management. Br J Anaesth. 2012;109(Suppl 1):i68–85.CrossRefGoogle ScholarPubMed
Lynn, LA, Curry, JP. Patterns of unexpected in-hospital deaths: a root cause analysis. Patient Saf Surg. 2011;5(1):3.CrossRefGoogle ScholarPubMed
Lamberti, JP. Respiratory monitoring in general care units. Respir Care. 2020;65(6):870–81.CrossRefGoogle ScholarPubMed
Prasad, S, O’Neill, S. Respiratory failure. Surgery (Oxford). 2021;39(10):654–9.CrossRefGoogle Scholar
Khanna, A, Saager, L, Bergese, SD, et al. Opioid-induced respiratory depression increases hospital costs and length of stay in patients recovering on the general care floor. BMC Anesthesiol. 2021;21(1):88.CrossRefGoogle ScholarPubMed
Jones, PM, Cherry, RA, Allen, BN, et al. Association between handover of anesthesia care and adverse postoperative outcomes among patients undergoing major surgery. JAMA. 2018;319(2):143.CrossRefGoogle ScholarPubMed
van Schaik, EPC, Blankman, P, Van Klei, WA, et al. Hypoxemia during procedural sedation in adult patients: a retrospective observational study. Can J Anesth. 2021;68(9):1349–57.CrossRefGoogle ScholarPubMed
Stone, AB, Brovman, EY, Greenberg, P, Urman, RD. A medicolegal analysis of malpractice claims involving anesthesiologists in the gastrointestinal endoscopy suite (2007–2016). J Clin Anesth. 2018;48:15–20.CrossRefGoogle ScholarPubMed
Yeh, T, Beutler, SS, Urman, RD. What we can learn from nonoperating room anesthesia registries: analysis of clinical outcomes and closed claims data. Curr Opin Anesthesiol. 2020;33(4):527–32.CrossRefGoogle ScholarPubMed
McGrath, SP, McGovern, KM, Perreard, IM, et al. Inpatient respiratory arrest associated with sedative and analgesic medications: impact of continuous monitoring on patient mortality and severe morbidity. J Patient Saf. 2021;17(8):557–61.CrossRefGoogle ScholarPubMed
Wier, LM, Henke, R, Friedman, B. Diagnostic groups with rapidly increasing costs, by payer, 2001–2007. In Healthcare Cost and Utilization Project (HCUP) Statistical Briefs. Rockville, MD: Agency for Healthcare Research and Quality (US), 2006, Feb. Statistical Brief 91.Google Scholar
Robbertze, R, Posner, KL, Domino, KB. Closed claims review of anesthesia for procedures outside the operating room. Curr Opin Anesthesiol. 2006;19(4):436–42.CrossRefGoogle ScholarPubMed
Metzner, J, Posner, KL, Domino, KB. The risk and safety of anesthesia at remote locations: the US closed claims analysis. Curr Opin Anesthesiol. 2009;22(4):502–8.CrossRefGoogle ScholarPubMed
Urman, RD, Moucharite, M, Flynn, C, Nuryyeva, E, Ray, CE. Impact of respiratory compromise in inpatient interventional radiology procedures with moderate sedation in the United States. Radiology. 2019;292(3):702–10.CrossRefGoogle ScholarPubMed
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(03):E340–51.Google ScholarPubMed
Ishikawa, M, Sakamoto, A. Postoperative desaturation and bradypnea after general anesthesia in non-ICU patients: a retrospective evaluation. J Clin Monit Comput. 2020 Feb;34(1):81–7.CrossRefGoogle ScholarPubMed
Slagelse, C, Vilmann, P, Hornslet, P, Jørgensen, HL, Horsted, TI. The role of capnography in endoscopy patients undergoing nurse-administered propofol sedation: a randomized study. Scand J Gastroenterol. 2013;48(10):1222–30.CrossRefGoogle ScholarPubMed
Beitz, A, Riphaus, A, Meining, A, et al. Capnographic monitoring reduces the incidence of arterial oxygen desaturation and hypoxemia during propofol sedation for colonoscopy: a randomized, controlled study (ColoCap Study). Am J Gastroenterol. 2012;107(8):1205–12.CrossRefGoogle ScholarPubMed
Campbell, SG, Magee, KD, Zed, PJ, et al. End-tidal capnometry during emergency department procedural sedation and analgesia: a randomized, controlled study. World J Emerg Med. 2016;7(1):13–8.CrossRefGoogle ScholarPubMed
Friedrich-Rust, M, Welte, M, Welte, C, et al. Capnographic monitoring of propofol-based sedation during colonoscopy. Endoscopy. 2014;46(3):236–44.Google ScholarPubMed
Klare, P, Reiter, J, Meining, A, et al. Capnographic monitoring of midazolam and propofol sedation during ERCP: a randomized controlled study (EndoBreath Study). Endoscopy. 2016;48(1):42–50.Google ScholarPubMed
Mehta, PP, Kochhar, G, Albeldawi, M, et al. Capnographic monitoring in routine EGD and colonoscopy with moderate sedation: a prospective, randomized, controlled trial. Am J Gastroenterol. 2016;111(3):395.CrossRefGoogle ScholarPubMed
Qadeer, MA, Vargo, JJ, Dumot, JA, et al. Capnographic monitoring of respiratory activity improves safety of sedation for endoscopic cholangiopancreatography and ultrasonography. Gastroenterology. 2009;136(5):1568–76; quiz 1819–20.CrossRefGoogle ScholarPubMed
Zongming, J, Zhonghua, C, Xiangming, F. Sidestream capnographic monitoring reduces the incidence of arterial oxygen desaturation during propofol ambulatory anesthesia for surgical abortion. Med Sci Monit. 2014;20:2336–42.Google ScholarPubMed
Bellolio, MF, Gilani, WI, Barrionuevo, P, et al. Incidence of adverse events in adults undergoing procedural sedation in the emergency department: a systematic review and meta-analysis. Acad Emerg Med. 2016;23(2):119–34.CrossRefGoogle ScholarPubMed
Campbell, SG, Magee, KD, Kovacs, GJ, et al. Procedural sedation and analgesia in a Canadian adult tertiary care emergency department: a case series. Can J Emerg Med. 2006 Mar;8(2):85–93.CrossRefGoogle Scholar
Cravero, JP, Beach, ML, Blike, GT, et al. The incidence and nature of adverse events during pediatric sedation/anesthesia with propofol for procedures outside the operating room: a report from the Pediatric Sedation Research Consortium. Anesth Analg. 2009;108(3):795.CrossRefGoogle ScholarPubMed
Green, RS, Butler, MB, Campbell, SG, Erdogan, M. Adverse events and outcomes of procedural sedation and analgesia in major trauma patients. J Emerg Trauma Shock. 2015;8(4):210–5.CrossRefGoogle ScholarPubMed
Kamat, PP, McCracken, CE, Gillespie, SE, et al. Pediatric critical care physician-administered procedural sedation using propofol: a report from the Pediatric Sedation Research Consortium database. Pediatr Crit Care Med. 2015;16(1):11.CrossRefGoogle ScholarPubMed
McGrane, O, Hopkins, G, Nielson, A, Kang, C. Procedural sedation with propofol: a retrospective review of the experiences of an emergency medicine residency program 2005 to 2010. Am J Emerg Med. 2012;30(5):706–11.CrossRefGoogle ScholarPubMed
Sayfo, S, Vakil, KP, Alqaqa’a, A, et al. A retrospective analysis of proceduralist-directed, nurse-administered propofol sedation for implantable cardioverter–defibrillator procedures. Heart Rhythm. 2012;9(3):342–6.CrossRefGoogle ScholarPubMed
Erden, IA, Pamuk, AG, Akinci, SB, Koseoglu, A, Aypar, U. Comparison of two ketamine–propofol dosing regimens for sedation during interventional radiology procedures. Minerva Anestesiol. 2009;76(4):260–5.Google ScholarPubMed
Karamnov, S, Sarkisian, N, Grammer, R, Gross, WL, Urman, RD. Analysis of adverse events associated with adult moderate procedural sedation outside the operating room. J Patient Saf. 2017;13(3):111–21.CrossRefGoogle ScholarPubMed
Martin, JG, Bercu, ZL, Becker, L, et al. Modifying institutional guidelines reduces the likelihood of oversedation during interventional procedures. J Am Coll Radiol. 2018;15(8):1185–7.CrossRefGoogle ScholarPubMed
Hinkelbein, J, Lamperti, M, Akeson, J, et al. European Society of Anaesthesiology and European Board of Anaesthesiology guidelines for procedural sedation and analgesia in adults. Eur J Anaesthesiol. 2018;35(1):6–24.CrossRefGoogle ScholarPubMed
Practice guidelines for moderate procedural sedation and analgesia 2018: a report by the American Society of Anesthesiologists Task Force on Moderate Procedural Sedation and Analgesia, the American Association of Oral and Maxillofacial Surgeons, American College of Radiology, American Dental Association, American Society of Dentist Anesthesiologists, and Society of Interventional Radiology. Anesthesiology. 2018;128(3):437–79.CrossRefGoogle Scholar
Jarzyna, D, Jungquist, CR, Pasero, C, et al. American Society for Pain Management Nursing guidelines on monitoring for opioid-induced sedation and respiratory depression. Pain Manag Nurs. 2011;12(3):118–145.e10.CrossRefGoogle ScholarPubMed
Tran, TT, Beutler, SS, Urman, RD. Moderate and deep sedation training and pharmacology for nonanesthesiologists: recommendations for effective practice. Curr Opin Anesthesiol. 2019;32(4):457–63.CrossRefGoogle ScholarPubMed

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