Recommendations for Patient Monitoring
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Monitoring Patient Level of Consciousness
• Periodically (e.g., at 5-min intervals) monitor a patient’s response to verbal commands during moderate sedation, except in patients who are unable to respond appropriately (e.g., patients where age or development may impair bidirectional communication) or during procedures where movement could be detrimental
• During procedures where a verbal response is not possible (e.g., oral surgery, restorative dentistry, upper endoscopy), check the patient’s ability to give a “thumbs up” or other indication of consciousness in response to verbal or tactile (light tap) stimulation; this suggests that the patient will be able to control his airway and take deep breaths if necessary
Monitoring Patient Ventilation and Oxygenation
• Continually monitor ventilatory function by observation of qualitative clinical signs
• Continually monitor ventilatory function with capnography unless precluded or invalidated by the nature of the patient, procedure, or equipment
• For uncooperative patients, institute capnography after moderate sedation has been achieved
•Continuously monitor all patients by pulse oximetry with appropriate alarms
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Monitoring Hemodynamics
• Determine blood pressure before sedation/analgesia is initiated unless precluded by lack of patient cooperation
• Once moderate sedation/analgesia is established, continually monitor blood pressure (e.g. at least at 5-min intervals) and heart rate during the procedure unless such monitoring interferes with the procedure (e.g., magnetic resonance imaging where stimulation from the blood pressure cuff could arouse an appropriately sedated patient)
• Use electrocardiographic monitoring during moderate sedation in patients with clinically significant cardiovascular disease or those who are undergoing procedures where dysrhythmias are anticipated
Contemporaneous Recording of Monitored Parameters
• Record patients’ level of consciousness, ventilatory and oxygenation status, and hemodynamic variables at a frequency that depends on the type and amount of medication administered, the length of the procedure, and the general condition of the patient
• At a minimum, this should occur (1) before the administration of sedative/analgesic agents, (2) after administration of sedative/analgesic agents, (3) at regular intervals during the procedure, (4) during initial recovery, and (5) just before discharge
• Set device alarms to alert the care team to critical changes in patient status
Availability of an Individual Responsible for Patient Monitoring
• Assure that a designated individual other than the practitioner performing the procedure is present to monitor the patient throughout the procedure
• The individual responsible for monitoring the patient should be trained in the recognition of apnea and airway obstruction and be authorized to seek additional help
• The designated individual should not be a member of the procedural team but may assist with minor, interruptible tasks once the patient’s level of sedation/analgesia and vital signs have stabilized, provided that adequate monitoring for the patient’s level of sedation is maintained