Department of Anesthesiology, Amsterdam University Medical Centers UMC, Location AMC, Amsterdam, The Netherlands.
Curr Opin Anaesthesiol. 2019 Dec;32(6):769-775. doi: 10.1097/ACO.0000000000000777.
There is a steadily increasing demand for procedural sedation outside the operating room, frequently performed in comorbid high-risk adult patients. This review evaluates the feasibility and advantages of sedation vs. general anesthesia for some of these new procedures.
Generally, sedation performed by experienced staff is safe. Although for some endoscopic or transcatheter interventions sedation is feasible, results of the intervention might be improved when performed under general anesthesia. For elected procedures like intra-arterial treatment after acute ischemic stroke, avoiding general anesthesia and sedation at all might be the optimal treatment.
Anesthesiologists are facing continuously new indications for procedural sedation in sometimes sophisticated diagnostic or therapeutic procedures. Timely availability of anesthesia staff will mainly influence who is performing sedation, anesthesia or nonanesthesia personal. While the number of absolute contraindications for sedation decreased to almost zero, relative contraindications are becoming more relevant and should be tailored to the individual procedure and patient.
越来越多的非手术室操作需要进行镇静，这些操作通常在合并多种高危因素的成年患者中进行。本综述评估了镇静与全身麻醉在某些新操作中的可行性和优势。
由有经验的医护人员实施的镇静通常是安全的。尽管对于一些内镜或经导管介入，镇静是可行的，但在全身麻醉下进行干预可能会改善干预结果。对于急性缺血性脑卒中后的动脉内治疗等选择性操作，避免全身麻醉和镇静可能是最佳治疗方法。
麻醉医生正不断面临新的镇静操作适应证，这些适应证涉及复杂的诊断或治疗操作。麻醉人员的及时可用性将主要影响谁来实施镇静，是麻醉人员、还是非麻醉人员。虽然镇静的绝对禁忌证数量几乎降为零，但相对禁忌证变得更加相关，应根据具体操作和患者量身定制。
