Procedural Sedation by Nonanesthesia Providers

Although anesthesiologists and certified registered nurse anesthetists are experts in sedation/analgesia outside of the operating room, extensive demand in the face of limited resources has resulted in sedation being routinely performed by nonanesthesia health care providers. Safe administration of procedural sedation/analgesia by nonanesthesia professionals requires an understanding of the continuum of sedation/general anesthesia; extensive training and credentialing of personnel performing sedation; appropriate patient preparation and selection, with an anesthesia consult for higher-risk patients; adherence to fasting guidelines, standard equipment, and monitoring procedures; and a thorough knowledge of the pharmacologic and physiologic properties of sedative and analgesic drugs. This chapter briefly reviews the essential elements needed to develop a safe policy for sedation by nonanesthesia practitioners.