Patient sedation

• Sedation is “a state of reduced excitement or anxiety that is induced by the administration of a sedative agent”¹.
• General anesthesia is described as “a state of total unconsciousness resulting from anesthetic drug(s)”¹.
• Furthermore, sedation can be sub-classified by degree²:
  • Minimal sedation where medications are administered to reduce anxiety, where the patient remains conscious and responds normally to verbal commands
  • Moderate sedation where a minimally depressed level of consciousness is induced by the administration of pharmacologic agents, where the patient retains a continuous and independent ability to maintain protective reflexes, a patent airway, and to be aroused by physical or verbal stimulation
  • Deep sedation where a depression of consciousness is induced through the administration of medication, patients cannot be easily aroused but still respond purposefully following repeated or painful stimulation
• The primary goals of sedation are to³:
  • Control patient behaviour, especially movement
  • Minimize pain
  • Minimize psychological disturbances and distress

• The most commonly encountered complications during sedation include⁴:
  • Hypotension
  • Desaturation
  • Excessive/prolonged sedation
  • Nausea and/or vomiting
• Guidelines for monitoring sedated patients differ depending on the medication administered.
  • The Compendium for Pharmaceuticals and Specialities (CPS) provides information on each form of sedation
  • Generally these monitoring procedures will be prescribed by the physician who prescribed the sedation

Discharge

• The patient leaves the recovery area only when vital signs and level of consciousness are at acceptable levels as determined by facility policy².
• Patients should not drive a vehicle following sedation
  • It is confirmed by the appropriate professional that the patient has made arrangements for transportation following discharge
  • A patient may need to identify a responsible caregiver for the period following sedation

Considerations for the MRI environment

• For the MRI environment, monitoring equipment must⁵:
  • Be free of ferrous components that could become dangerous projectiles
  • Function within a magnetic field
  • Be replaced by MRI-safe options if they pose risk for shock or burns

• MRTs consider personnel needs and arrange assistance prior to the procedure or treatment to ensure safe and high quality patient outcomes.
• Appropriate equipment and supplies for monitoring are available, including all the tools necessary to monitor the physiological measurements listed above.
  • The MRT knows the location of the emergency cart or kit and is able to retrieve these resuscitative equipment/supplies immediately in case of need²
  • Access to resuscitative equipment (e.g., suction, oxygen) is assured throughout the procedure/treatment and recovery phase²

Monitoring

• For procedures and treatment performed with sedation, the MRT must be accompanied by another qualified healthcare practitioner to monitor the patient throughout².
  • The monitoring, medicating, and care of the patient is the primary focus of this second qualified professional
  • The extent to which the MRT is involved in patient monitoring and other aspects of care of sedated patient depends on the degree of sedation as well as facility policy
• MRTs who deal with sedated patients should be educated to recognize and manage complications quickly and efficiently to minimize permanent injury⁴.

Discharge

• Generally the professional who took responsibility for monitoring the patient would also be responsible for seeing that requirements for discharge are met.
• MRTs who have undertaken the monitoring of a patient are responsible for familiarity with the discharge policy at their facility and for confirming that patients do not plan to drive a vehicle following sedation.