In-Office Conscious Sedation Is Safe When Used Properly

In addition to monitoring equipment and reversing medication, the facility needs to have the equipment necessary to intubate, should the occasion arise, including a laryngoscope. The cart needs to be checked on a regular basis, and the staff needs to be trained in conscious sedation, Dr. Carruthers added. Ideally an anesthesiologist should be present. It’s an excellent technique, but it’s one level short of general anesthesia and you need to manage it properly, and the facilities should be accredited by a proper accrediting agency.

Although the thought of yet another accreditation process may be daunting, it should be a collaborative experience between the facility and the accreditation agency, he said. I find the accreditation process nothing but helpful, Dr. Carruthers said, adding that if the facility’s effort to strive for excellence is obvious, the accreditation staff will become more relaxed over time.

He agreed with Dr. Papel that patients should be advised not only not to drive, but to bring a driver rather than relying on a cab, and to delay important decisions for 48 hours after having been sedated.

Although his preference is for an anesthesiologist to monitor the conscious sedation, he added that there is a role for surgeons to administer it under certain circumstances. I think a physician licensed to practice should be able to do what he or she is trained to do, he said. If an individual goes through a prescribed course of training to safely administer and supervise conscious, that’s fine.

However, he stressed that the key is safety. The person administering the sedation-an anesthesiologist, surgeon, or nurse anesthetist-needs to be able to concentrate on an individual if things go wrong, he said.

©2006 The Triological Society