Department of Anesthesiology and Pain Medicine, Yeouido St. Mary's Hospital, School of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
J Anesth. 2013 Apr;27(2):218-23. doi: 10.1007/s00540-012-1497-0. Epub 2012 Oct 18.
Procedural sedation during diagnostic or therapeutic procedures is currently widely used by clinicians across a broad range of specialties. However, procedural sedation is a poorly controlled practice in many countries, often performed in potentially unsafe environments.
In 2009, the Legislation Committee of the Korean Society of Anesthesiologists, based on expert consultation referrals provided by police departments, civil courts, and criminal courts, initiated the construction of database to compile all anesthesia-related adverse events. Using this database (July 2009 to April 2012), we have compared causative mechanisms and injury patterns in procedural sedation (Sedation) cases (N = 25) with those in general anesthesia (GA) cases (N = 29).
The severity of injury in Sedation cases was similar to that in GA cases, with death occurring in 72.0 % of cases. Hypoxia secondary to airway obstruction or respiratory depression was the most common specific mechanism of Sedation-related injuries (64.0 %). In-depth analysis of pre-procedural evaluation and intraoperative monitoring revealed a common lack of vigilance in the Sedation cases, and most injuries were judged as preventable with better monitoring. Non-anesthesiologist administration of propofol (NAAP) was performed in the great majority of Sedation cases (88.0 %).
Our analysis of procedural sedation based on anesthesia-related adverse events compiled in the national database revealed a high severity of patient injury similar to that due to general anesthesia. Most procedural sedations were shown to be poorly controlled without adequate pre-procedural patient evaluation or intraoperative monitoring. Thus, it is essential to establish proper practical guidelines for procedural sedation and ensure strict adherence to these guidelines, especially during the NAAP.
在诊断或治疗过程中进行程序镇静目前已被广泛应用于多个医学专科的临床医生。然而，在许多国家，程序镇静的实践管理较差，通常在潜在不安全的环境中进行。
2009 年，韩国麻醉医师学会立法委员会根据警察局、民事法庭和刑事法庭提供的专家咨询意见，启动了数据库的建设，以收集所有与麻醉相关的不良事件。使用该数据库（2009 年 7 月至 2012 年 4 月），我们比较了程序镇静（镇静）病例（N=25）与全身麻醉（GA）病例（N=29）的病因机制和损伤模式。
镇静病例的损伤严重程度与 GA 病例相似，死亡率为 72.0%。气道阻塞或呼吸抑制导致的缺氧是镇静相关损伤最常见的特定机制（64.0%）。对术前评估和术中监测的深入分析显示，镇静病例普遍缺乏警觉，大多数损伤可通过更好的监测来预防。大多数镇静病例均由非麻醉医师使用丙泊酚（NAAP）进行（88.0%）。
我们根据国家数据库中汇编的与麻醉相关的不良事件对程序镇静进行的分析显示，患者损伤的严重程度与全身麻醉相似。大多数程序镇静的管理较差，没有充分的术前患者评估或术中监测。因此，制定适当的程序镇静实践指南并确保严格遵守这些指南至关重要，尤其是在非麻醉医师使用丙泊酚时。
