Healthcare and Medicine Reference
Administer supplemental oxygen to the patient. Nasal cannulae
with a fl ow rate of 2-4 L/min are suitable, but will only provide
inspired oxygen levels of 24-35%.
Attach monitoring (minimum: continual pulse oximetry).
A high standard of monitoring is essential - continuous heart
rate and oxygen saturations, and intermittent non-invasive blood
pressure are recommended.
Never underestimate the potential dangers of sedation - always
Administer an increment of sedation according to the guide-
lines above. Typically this will be 2-4 mL of the agent.
Assess for response after 2-3 minutes. The patient should be
have a back-up plan.
Be aware of respiratory or cardiac depression once a painful
comfortable and able to talk, but calm and slightly obtunded.
If the patient remains anxious or is wide awake, consider a fur-
ther dose of ¼ to ½ the original bolus. Reassess and repeat again
Monitor continuously by verbal communication, clinical signs
stimulus has been removed: this may be apparent after successful
British National Formulary
Rosenberg PH. (2000) Local and Regional Anaesthesia , Wiley-Blackwell,
UK Academy of Medical Royal Colleges and Their Faculties. (2001)
Implementing and Ensuring Safe Sedation Practice for Healthcare Procedures
in Adults . www.rcoa.ac.uk/docs/safesedationpractice.pdf
Watts J. (2008) Safe Sedation for all Practitioners: A Practical Guide . Radcliffe
Whitwam JG, McCloy RF, eds. (1998) Principles and Practice of Safe Sedation ,
2nd edn. Blackwell Science, Oxford.
and pulse oximetry (minimum).
Follow emergency protocols should the patient's airway be
compromised or should they become unconscious.
If the patient becomes agitated or distressed during the proce-
dure, give a further dose of ¼ to ½ the original bolus. Reassess
and repeat again if necessary.
Discontinue continuous monitoring only once the patient is
fully awake and all observations are satisfactory.
Document the agent(s) used and any complications, and ensure
that the observations are recorded accurately.