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Patient sedation

 

MRTs ensure adequate preparations are made for patients undergoing sedation during their procedure or treatment

 

+ 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
    • 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 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

Preparation

  • 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 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

 

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.

+ References

  1. 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.
  2. 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.
  3. Westbrook C. Handbook of MRI technique. 3rd Ed. Cambridge, UK: Blackwell Publishing Ltd.; 2008.
  4. Patatas K, Koukkoulli A. The use of sedation in the radiology department. Clin Radiol 2009;64(7):655-663.
  5. 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.

 

 

Validation

November, 2015

 

 
Canadian Association of Medical Radiation Technologists
85 Albert St, Suite 1000, Ottawa, ON, K1P 6A4
phone: 613 234-0012 / 800 463-9729
fax: 613 234-1097
www.camrt.ca