The two most controversial anesthetics administered by non-anesthetic providers are propofol and ketamine. Ketamine is most commonly used in the emergency room for pediatric deep sedation and is not covered in this article. Patients with Mallampati class III and IV should receive an anaesthesia consultation prior to moderate sedation. The literature has shown that the higher the Mallampati classification assigned, the higher the incidence of difficult intubation. The sedation nurse should also be aware of the patient`s range of motion in the neck. Restrictions on excessive stretching of the head and neck, such as Arthritis can lead to a lack of neck mobility, which can affect the patient`s airway, making intubation difficult.22 The nurse using the Mallampati classification can better understand the effectiveness of head tilt and chin lift maneuver. The next morning, LB was taken to the operating room and seen by co-accused SK, an anesthesiologist, who stated that she would perform the anesthesia under the supervision of Dr. D. The plaintiffs provided evidence that LB suffered severe physical and mental impairment as a result of his cardiac arrest. The plaintiffs sued Dr. D and SK, alleging: (1) violation of the doctrine of consent; 2) Dr.

D`s negligence in his preoperative assessment of BL and SK`s authorization to perform anesthesia in Dr. D.`s absence. D administer; and 3) KS`s negligence in administering general anesthetic drugs, attempts to resuscitate BL once the problem has been detected, and delay in Dr. D`s call for help. The plaintiff in this case, LB, arrived at the hospital in the afternoon to perform exploratory abdominal surgery the following day. Upon arrival, LB signed several forms for 20 minutes, including one stating that he was aware of the risks of general anesthesia for his surgery. After completing the preanesthetic “checklist,” LB met with Dr. D, the defendant, for a preoperative evaluation. LB testified that during his meeting, Dr.

D. told him that he recommended general anesthesia, that he would perform the procedure in person, and asked him if he had any questions about the proposed anesthesia plan. LB also testified that Dr. D did not disclose any of the risks associated with general anesthesia or any of the other types of anesthesia available. In summary, it is important to remember that informed consent is not just a signed document, but an interactive discussion between the anesthesiologist and the patient that illustrates the principles of joint decision-making.9 It is important for patients to understand the unpredictability of perioperative outcomes and to educate them about the risk of unexpected adverse events in addition to other forms of anesthesia. 4 Nurses are constantly involved in the ongoing management of patients receiving tranquilizers or analgesics during invasive diagnostic or therapeutic procedures. Medication administration, patient monitoring, discharge courses and family education are among the top patient safety concerns. All are elements of care performed directly by the nurse. The State Nursing Councils define the scope of practice with varying degrees of specificity.

However, it is the sole legal responsibility of every nurse to familiarize themselves with the guidelines and directives of the state nursing board, regardless of the wide variations in clinical settings in which moderate sedation is administered. These settings include diagnostic/interventional radiology/cardiology settings, dental and oral surgery centers, stand-alone endoscopy centers, emergency rooms, plastic surgery centers, and other ambulatory settings that may or may not be connected to an acute care facility. It is also advisable to discuss alternatives to general anaesthesia with the patient and make recommendations by means of a risk-benefit analysis. Most patients are likely to agree with the professional opinion of an anesthesiologist. Complete documentation of the consent process is essential to avoid litigation. First of all, it is important that an anesthesia practice has its own specific anesthesia consent, which is separate from the hospital and operation consents. Consent to anesthesia should describe the risks, benefits and alternatives of anesthesia, which can be very different from surgical risks. Unilateral consent is also preferable to multi-page consent because it reduces the likelihood of losing the signature page and makes it more difficult for a patient to argue that they did not understand the form or did not have enough time to read it.7 The registered nurse performing the sedation must know and know the scope of the registered nursing practice in their condition. their institution`s policies, as well as Joint Commission, AANA and ASA guidelines for patient monitoring, medication administration, and protocols for dealing with potential complications or emergencies during and after sedation. The AAMSN area of practice for non-anesthetic RNs is another reference.23 Legal and ethical controversies for non-anesthesiologist RNs who administer sedation are of concern to both the American Association of Nurse Anesthetists and the American Society of Anesthesiologists, primarily due to the introduction of midazolam as a sedative, which has been responsible for 83 reported deaths due to lack of adequate practitioner training.13 Intent of the Sedation certification, In its commitment to administering safe sedation, it was not to develop a national AASB certification, but to offer a program that offers a sedation certification that certifies all standards and guidelines from all accreditation bodies for healthcare facilities, including the next accreditation body for conscious sedation.

These include the Joint Commission for Health Care Organizations, the National Intergraded Accreditation for Health Care Organizations (NIAHO) in collaboration with Det Norske Ventas (DNV), the Health Care Accreditation Association for Ambulatory Health Care (AAAHC) and the Healthcare Facility Accreditation Program (HFAP). Shortly after SK began administering medication to induce general anesthesia, LB`s airway partially blocked and he began to have difficulty breathing. SK tried corrective measures, but they failed, and she then called for help. The exact time that elapsed between SK first acknowledging the critical situation and first seeking help from Dr. D. was a controversial issue in the trial. Within minutes of the call for help, many doctors entered the room, including Dr. D. After several attempts, doctors failed to establish an airway for LB, and shortly thereafter, the patient suffered cardiac arrest. Patients need to be educated about the material risks of anesthesia, but many doctors are not aware of what is “material.” Typically, property hazards are considered common but minor injuries (such as tooth damage and nausea) or rare but serious injuries (such as death or nerve damage). However, the Oregon State Nursing Council adopted the position in 2006 that it is common for Licensed Practical Nurses (LPNs), Registered Nurses (RNs), Nurse Practitioners (NPs), and Clinical Nurse Specialists (CNSs) to administer sedatives for anxiolysis purposes.10 The standards of the Joint Commission for Sedation and Anesthesia Care do not require the granting of privileges for the administration of minimal sedation (anxiolysis).

Patients on minimal and moderate sedation continue to respond normally to verbal commands and have normal cardiovascular ventilation function, although their cognitive function and coordination may be impaired. A frequently asked question is; Does the minimally sedated patient sedation nurse have to meet the same standard of training as a registered nurse performing moderate sedation? By definition, however, no, given the continuum of care and the requirement that the sedation nurse be able to save a lower level, intentionally or accidentally, the minimal sedation nurse would be responsible for meeting the same requirement as the moderate sedation nurse.11 The Supreme Court held that: Although alternative forms of anesthesia, such as regional or local anaesthesia, themselves carried inherent risks (perhaps even greater than general anaesthesia), LB should have been informed of this and given the opportunity to make the decision itself. Although LB had no questions about anesthesia, Dr. D always obliged to discuss risks and alternatives, because LB may have made a different choice. After it was shown that Dr. D. had failed to inform the patient of an important fact (in this case, alternatives to general anesthesia) and that LB had given consent without full knowledge of those essential facts, the jury ultimately decided whether a reasonably prudent patient would have consented in similar circumstances had he known of alternatives to general anesthesia (RCW 7.70.050). Respiratory treatment is the most important and controversial issue in sedation of nurses without anesthesia. Proper airway assessment is crucial. It is non-invasive and can be completed quickly with a simple observation. LEMON mnemonics contain the following observations for patient evaluation:20 The classification of ASD can be controversial when gray areas are misinterpreted or intentionally downgraded to be prone to sedation rather than anesthesia.