AD.7 Unintended deep sedation general anesthesia

It is the standard of this organization that appropriate equipment and trained individuals are available to deliver 
and monitor sedation and anesthesia as well as manage recovery of the patient from an unintended state of deep 
sedation or general anesthesia. 
Because sedation is a continuum, it is not always possible to predict how an individual patient will respond.  Due to 
extremely rapid action and high potency of certain medications used in sedation there may be times when it is difficult to attain the desired level of sedation and or in fact there may be an induced but unintended state of deep sedation/general anesthesia. 
Even if moderate sedation is intended, patients should receive care consistent with that required for deep sedation. Therefore, the anesthesia provide or physician administering IV sedation must be competent to recognize a state of deeper sedation or general anesthesia and be able to rescue a patient experiencing any of the complications of deep sedation or general anesthesia. 
Positive airway pressure may be required because of depressed spontaneous ventilation or drug-induced dependence of neuromuscular function.   A patient under general anesthesia is at risk for life-threatening respiratory and cardiovascular changes, including hypoxia, hypoventilation, bradycardia, tachycardia, hypotension and hypertension.
Because patients may enter a state of deep sedation or general anesthesia even though a lower level of sedation was planned, this organization requires that the individual intending to administer deep sedation be skilled in recognizing signs of deeper than desired sedation and be qualified to rescue patients from general anesthesia which would include management of an unstable cardiovascular system as well as a compromised airway; inadequate oxygenation and ventilation.  The individual providing sedation should have advanced cardiac life support certification/skills and/or pediatric life support certification/skill if sedating pediatric patients and an understanding of the pharmacology of the medications used.  
Certain medications used in sedation such as Propofol do not have an antagonist medication that can be used if moderate sedation becomes deep sedation, therefore in this organization only physicians can administer 
Propofol as per their credentials and privileges granted.

Approved By Governing Board
Control #344.2
Gupta Gastro