+ What is 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 degree:2
- 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 to:3
- Control patient behaviour, especially movement
- Minimize pain
- Minimize psychological disturbances and distress
+ Patient safety considerations
- The most commonly encountered complications during sedation include:4
- 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
- The patient leaves the recovery area only when vital signs and level of consciousness are at acceptable levels as determined by facility policy.2
- 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 must:5
- 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
+ MRT's role in sedation
- 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
- For procedures and treatment performed with sedation, the MRT must be accompanied by another qualified healthcare practitioner to monitor the patient throughout.2
- 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 injury.4
- 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.
- Canadian Anesthesiologists’ Society. Guidelines to the Practice of Anesthesia*. Appendix 6: Position Paper on Procedural Sedation: An Official Position Paper of the Canadian Anesthesiologists’ Society. Available at: http://www.cas.ca/English/Page/Files/97_Appendix%206.pdf. Accessed June 9, 2015.
- American College of Radiology. ACR–SIR Practice Guideline for Sedation/Analgesia. 2015. Available at: http://www.acr.org/~/media/F194CBB800AB43048B997A75938AB482.pdf. Accessed January 20, 2016.
- Westbrook C. Handbook of MRI technique. 3rd Ed. Cambridge, UK: Blackwell Publishing Ltd.; 2008.
- Patatas K, Koukkoulli A. The use of sedation in the radiology department. Clin Radiol 2009;64(7):655-663.
- Lucille Packard Children’s Hospital, Stanford University Medical Center. Pediatric Anesthesia and Pain Management: Practice Guidelines for the MRI & MRT. Available at: http://pedsanesthesia.stanford.edu/downloads/guideline-mri.pdf. Accessed February 24, 2012.