1Department of Internal Medicine, Dongguk University Ilsan Hospital, College of Medicine, Dongguk University, Goyang, Korea
2Department of Internal Medicine, Keimyung University College of Medicine, Seoul, Korea
3Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, Korea
4Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
5Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
6Department of Internal Medicine, Kyung Hee University College of Medicine, Seoul, Korea
7Department of Internal Medicine, Yeongnam University College of Medicine, Daegu, Korea
Copyright © 2019 Korean Society of Gastrointestinal Endoscopy
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Modified from American Society of Anesthesiologists Task Force on Sedation and Analgesia by Non-Anesthesiologists. [1]
Modified from Aldrete et al. [4]
BP, blood pressure.
Modified from Chernik et al. [7]
Minimal sedation (anxiolysis) | Moderate sedation (conscious sedation) | Deep sedation | General anesthesia | |
---|---|---|---|---|
Responsiveness | Normal response to verbal stimulation | Purposeful response to verbal and tactile stimulation | Purposeful response after repeated or painful stimulation | Unarousable even with painful stimulus |
Airway | Unaffected | No intervention required | Intervention may be required | Intervention often required |
Spontaneous ventilation | Unaffected | Adequate | May be inadequate | Frequently inadequate |
Cardiovascular function | Unaffected | Usually maintained | Usually maintained | May be impaired |
Category | AQEU assessment items | Grade |
---|---|---|
Mandatory items (12 items) | ||
Pre-procedure assessment (4 items) | 1. Prior to endoscopic sedation, the medical history of the patient must be verified and the physical status of the patient must be assessed, according to the physical status classification system approved by the American Society of Anesthesiologists. | Mandatory |
2. Prior to endoscopic sedation, the patient’s blood pressure, heart rate, respiratory rate, and oxygen saturation must be recorded. | ||
3. A recommended format of the consent form must be used, or all information needed for sedation consent must be included. In addition, the patient must be notified about the possibility of being accompanied by a guardian during endoscopic sedation, and the presence of this individual should be confirmed. | ||
4. Endoscopists and nurses must have completed their endoscopic sedation-related education. | ||
Intra-procedure assessment (3 items) | 1. During endoscopic sedation, monitoring and recording the patient’s blood pressure, heart rate, respiratory rate, and oxygen saturation in regular intervals is recommended. | Mandatory |
2. The type and dosage of drug(s) used for endoscopic sedation must be recorded and maintained. | ||
3. Guidelines on drug administration for endoscopic sedation must be available. | ||
Post-procedure assessment (3 items) | 1. There must be nurses assigned to the recovery room. | Mandatory |
2. After endoscopic sedation, the patient’s oxygen saturation and heart rate must be monitored and blood pressure must be measured regularly, from the time of admission to the recovery room until the time of discharge. | ||
3. After endoscopic sedation, the patient must be discharged in accordance with the designated criteria. | ||
Narcotics control (2 items) | 1. Narcotics used for endoscopic sedation must not be easily accessible by patients and must be stored in the narcotics storage facility with a lock. | Mandatory |
2. Narcotics must be dispensed immediately before administration and prepared in an independent area, such as a drug preparation room. | ||
Recommended items (5 items) | ||
Pre-procedure assessment (3 items) | 1. Regarding the ratio of beds in an examination room to those in the recovery room, a ratio of ≥2 is recommended. | Recommended |
2. Before initiating the endoscopic sedation, it is recommended to predict the risk of hypoxia and difficulty of endotracheal intubation based on the patient’s Mallampati score. | ||
3. Before initiating the endoscopic sedation, the patient’s level of consciousness should be assessed. | ||
Intra-procedure assessment (1 item) | 1. ECG monitoring during endoscopic sedation is recommended in patients with serious cardiovascular disease or arrhythmia. | Recommended |
Post-procedure assessment (1 item) | 1. ECG monitoring after endoscopic sedation is recommended in patients with serious cardiovascular disease or those who showed unstable vital signs during the procedure. | Recommended |
Parameters | Score | |
---|---|---|
Activity level | • Able to move all extremities voluntarily or on command | 2 |
• Able to move 2 extremities voluntarily or on command | 1 | |
• Cannot move extremities voluntarily or on command | 0 | |
Respiration | • Able to take deep breath and cough | 2 |
• Dyspnea/shallow breathing | 1 | |
• Apnea | 0 | |
Circulation | • BP within 20% of pre-anesthesia/sedation level | 2 |
• BP within 20%–50% of pre-anesthesia/sedation level | 1 | |
• BP >50% of pre-anesthesia/sedation level | 0 | |
Consciousness | • Fully awake | 2 |
• Arousable on calling | 1 | |
• Not responding | 0 | |
Oxygen saturation | • Maintains >92% on room air | 2 |
• Maintains >90% with supplemental oxygen | 1 | |
• Oxygen saturation <90% even with supplemental oxygen | 0 |
Description | Score |
---|---|
Responds readily to name spoken in normal tone | 5 |
Lethargic or slow response to name spoken in normal tone | 4 |
Responds only after name is called loudly and/or repeatedly | 3 |
Responds only after mild prodding or shaking | 2 |
Responds only after painful trapezius squeeze | 1 |
No response after painful trapezium squeeze | 0 |
Modified from American Society of Anesthesiologists Task Force on Sedation and Analgesia by Non-Anesthesiologists. [
AQEU, accreditation of qualified endoscopy unit; ECG, electrocardiogram.
Modified from Aldrete et al. [ BP, blood pressure.
Modified from Chernik et al. [