AORN Virtual Town Hall and Special Membership Meeting: February 23, 2016

Moderate Sedation/Analgesia

Get clinical answers to frequently asked questions about Moderate Sedation/Analgesia.

  • May the RN circulate while administering medications and monitoring the patient receiving moderate sedation/analgesia?
    No, the perioperative RN may not circulate and provide moderate sedation/analgesia simultaneously. At a minimum two perioperative RNs should care for the patient who is receiving moderate sedation/analgesia provided by the perioperative RN. The responsibilities of one RN is to monitor the patient, administer the sedation and analgesia medications, and continuously care for the patient throughout the procedure. The second RN is the circulator.

    Resource:

    • Guideline for care of the patient receiving moderate sedation/analgesia. In: Guidelines for perioperative practice. Denver, CO: AORN.
    Updated December 8, 2015
  • What parameters need to be monitored and documented intraoperatively when the patient is receiving moderate sedation/analgesia??

    Intraoperative patient monitoring and documentation should include 

    • cardiac rate and rhythm, 
    • blood pressure, 
    • respiratory rate, 
    • SpO2 by pulse oximetry, 
    • end-tidal CO2 by capnography, 
    • depth of sedation assessment,
    • pain level, 
    • anxiety level, and 
    • level of consciousness.
    Resource:
    • Guideline for care of the patient receiving moderate sedation/analgesia. In: Guidelines for perioperative practice. Denver, CO: AORN.
    Updated December 8, 2015
  • When caring for the patient receiving moderate sedation/analgesia, is capnography necessary if SpO2 is monitored with pulse oximetry?
    Yes, the perioperative RN should monitor exhaled CO2 (ie, end-tidal CO2 [EtCO2]) by capnography in addition to SpO2 by pulse oximetry during moderate sedation/analgesia procedures. Also, the perioperative RN should continuously observe the adequacy of the patient’s ventilation. Monitoring the patient’s EtCO2, SpO2, and performing visual assessments completes the cycle of respiratory monitoring of oxygenation and ventilation of patients undergoing moderate sedation/analgesia.

    Resources:

    • Guideline for care of the patient receiving moderate sedation/analgesia. In: Guidelines for perioperative practice. Denver, CO: AORN.
    • Standards for basic anesthetic monitoring. In: ASA’s Standards, Guidelines, and Statements. Park Ridge, IL: American Society of Anesthesiologists; 2015. http://www.asahq.org/quality-and-practice-management/standards-and-guidelines. Accessed December 7, 2015.
    • Cacho G, Perez-Calle JL, Barbado A, Lledo JL, Ojea R, Fernandez-Rodriguez CM. Capnography is superior to pulse oximetry for the detection of respiratory depression during colonoscopy. Rev Esp Enferm Dig. 2010;102(2): 86-89.
    Updated December 8, 2015
  • Does AORN recommend screening patients for obstructive sleep apnea if they are scheduled to have a procedure with moderate sedation?
    Yes, the perioperative RN administering moderate sedation/analgesia should assess the patient’s airway preoperatively for the risk of obstructive sleep apnea (OSA). The undiagnosed range of moderate to severe OSA is estimated at 82% for men and 92% for women. Surgical patients have a reported higher incidence than the general population. The number of patients with OSA is likely to increase as the population ages and becomes more obese.

    Resources:
    • Guideline for care of the patient receiving moderate sedation/analgesia. In: Guidelines for perioperative practice. Denver, CO: AORN.
    • Gross JB, Bachenberg KL, Benumof JL, et al. Practice guidelines for the perioperative management of patients with obstructive sleep apnea: a report by the American Society of Anesthesiologists Task Force on Perioperative Management of patients with obstructive sleep apnea. Anesthesiology. 2006; 104(5): 1081-93; quiz 1117-8. 
    • Joshi GP, Ankichetty SP, Gan TJ, Chung F. Society for Ambulatory Anesthesia consensus statement on preoperative selection of adult patients with obstructive sleep apnea scheduled for ambulatory surgery. Anesthesia & Analgesia. 2012; 115(5): 1060-1068. 
    • Chung F, Elsaid H. Screening for obstructive sleep apnea before surgery: why is it important? CURR OPIN ANESTHESIOL. 2009; 22(3): 405-411.
    Updated December 8, 2015
  • How should the patient be assessed and screened for obstructive sleep apnea?
    The perioperative RN should use a screening tool to assess the patient for obstructive sleep apnea (OSA). Obstructive sleep apnea screening tools are useful to classify patients based on clinical symptoms and risk factors to determine high-risk patients who may need a referral to a higher level of care (eg, an anesthesia professional) or additional diagnostic testing (ie, polysomnography). Typical questions in the screening tools include body mass index, neck size, age, sex, hypertension, loud snoring, apnea during sleep, and tiredness during the day.

    Resources:

    • Guideline for care of the patient receiving moderate sedation/analgesia. In: Guidelines for perioperative practice. Denver, CO: AORN.
    • Abrishami A, Khajehdehi A, Chung F. A systematic review of screening questionnaires for obstructive sleep apnea. Canadian Journal of Anaesthesia. 2010; 57(5): 423-438. 
    Updated December 8, 2015
  • Why is it necessary to know if a patient has obstructive sleep apnea?
    Preoperative awareness of a patient with obstructive sleep apnea (OSA) is important as the patient may experience complications associated with their OSA during perioperative care. Complications include cardiac dysrhythmias (eg, bradycardia, atrial fibrillation, premature ventricular contractions), myocardial infarction, severe oxygen desaturation, episodic hypoxemia, hypercapnia, respiratory arrest, airway obstruction, hypoventilation, unplanned intensive care unit admission, impaired arousal from sedation, and sudden death. Moderate sedation medications that affect the central nervous system may interfere with the normal respiratory compensatory mechanisms of hypoxemia and hypercarbia, and depressant medications may facilitate pharyngeal collapse in patients with OSA.

    Resources:

    • Guideline for care of the patient receiving moderate sedation/analgesia. In: Guidelines for perioperative practice. Denver, CO: AORN.
    • Abrishami A, Khajehdehi A, Chung F. A systematic review of screening questionnaires for obstructive sleep apnea. Canadian Journal of Anaesthesia. 2010; 57(5): 423-438. 

    Updated December 8, 2015
  • What is a brief, interruptible task?
    Examples of brief interruptible tasks are tying a sterile gown and opening supplies (eg, suture packet, lap sponges) that are within the room when the circulator is unavailable. The perioperative RN providing moderate sedation/analgesia may perform these ancillary, brief, interruptible, patient related tasks to assist the perioperative team while remaining inside the room. If the patient is receiving propofol for moderate sedation/analgesia, the RN providing the moderate sedation/analgesia should not perform short, interruptible tasks.

    Resource:
    • Guideline for care of the patient receiving moderate sedation/analgesia. In: Guidelines for perioperative practice. Denver, CO: AORN.
    Updated December 8, 2015
  • May the RN monitoring the patient receiving moderate sedation/analgesia leave the room at any time?
    The perioperative RN providing moderate sedation/analgesia should not leave the room. The RN should be in constant attendance with unrestricted immediate visual and physical access to the patient.

    Resource:

    • Guideline for care of the patient receiving moderate sedation/analgesia. In: Guidelines for perioperative practice. Denver, CO: AORN.
    Updated December 8, 2015