Pino Richard M
Department of Anesthesia and Critical Care, Massachusetts General Hospital, Boston, MA 02114, USA.
Curr Opin Anaesthesiol. 2007 Aug;20(4):347-51. doi: 10.1097/ACO.0b013e32827035c7.
Procedural sedation and monitored anesthesia care have become increasingly common in locations outside of the operating room. The different types of procedures are presented along with pertinent safety issues with the use of different drug combinations.
Based on the annual data from one hospital, of approximately 63,000 patients undergoing diagnostic or therapeutic procedures under sedation or anesthesia, 41% were sedated by non-anesthesiologists. Monitored anesthesia care was given to 0.4% of patients outside of the operating room. Events associated with monitored anesthesia care have been related to age, American Society of Anesthesiologists physical status, and obesity. Without the use of capnography, significant delays in the detection of apnea were demonstrable. Respiratory compromise with propofol for sedation appears less than that described for sedation using opiates and benzodiazepines.
The number and types of procedures done outside of the operating room are steadily increasing. Sedation for these is often provided by nonanesthesiologists. A quality assurance system dedicated to track events associated with procedural sedation and anesthesia done outside of the operating room is instrumental for the maintenance of exemplary quality of sedation and safety of our patients.
在手术室以外的场所，实施程序性镇静和监护下麻醉越来越普遍。本文介绍了不同类型的操作以及使用不同药物组合时相关的安全问题。
根据一家医院的年度数据，在约63000例接受镇静或麻醉下诊断或治疗性操作的患者中，41%由非麻醉医生实施镇静。在手术室以外的场所，0.4%的患者接受了监护下麻醉。与监护下麻醉相关的事件与年龄、美国麻醉医师协会身体状况分级和肥胖有关。若不使用二氧化碳监测仪，可明显发现呼吸暂停的检测存在显著延迟。丙泊酚用于镇静时的呼吸功能损害似乎比使用阿片类药物和苯二氮䓬类药物镇静时所描述的要轻。
手术室以外进行的操作数量和类型在稳步增加。这些操作的镇静通常由非麻醉医生提供。建立一个专门用于追踪手术室以外实施程序性镇静和麻醉相关事件的质量保证系统，对于维持出色的镇静质量和患者安全至关重要。
