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Requirements and circumstances for safe sedation.

Journal of the Korean Medical Association.2013;56(4):299-302. doi:10.5124/jkma.2013.56.4.299

The number of sedations performed for diagnostic and therapeutic procedures that do not require general anesthesia is increasing. As most sedations are performed by non-anesthesiologists, safety is has become a critical issue in light of recent adverse outcomes reported in the media. To ensure the safety of patients undergoing sedation for minor procedures, standards regarding patient selection, education, drugs, equipment, facilities, sedation protocols, recovery, and monitoring should be developed and publicized as they have been in the US and European countries. Guidelines developed regarding sedation and analgesia are similar and share their most important goal: patient safety. Any barriers that interfere with achieving this goal should be identified and eliminated. A Korean version of sedation guidelines should be developed. Guidelines that have both the clinical integrity of evidence and consideration of the real world should be developed and enforced.
Analgesia ; Anesthesia, General ; Dietary Sucrose ; Humans ; Light ; Patient Safety ; Patient Selection

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Drug abuse associated with procedural sedation.

Sang Hyun HONG

Journal of the Korean Medical Association.2013;56(4):292-298. doi:10.5124/jkma.2013.56.4.292

Procedural sedation is now becoming more popular in South Korea along with the increases in cosmetic procedures and surgery, gastrointestinal endoscopy, and minimally invasive surgery, which have been accompanied by a surge in propofol abuse. The mechanism of potential abuse of sedatives and hypnotics share the common feature of all addictive drugs, in that they increase dopamine concentrations in target structures in the mesolimbic dopamine system. The abuse of sedatives and hypnotics occupies a small proportion of all substance abuse; however, propofol abuse is sharply increasing and is closely associated with procedural sedation in South Korea. Previous case reports have indicated that the majority of propofol abusers were health-care providers; however, recreational use of propofol is spreading among the general public. Lay people become addicted to propofol through repetitive procedural sedation or wrongful use by clinicians who are enticed by the promise of monetary gain. Illicit distribution of propofol accelerates abuse by lay people. The extremely narrow safety margin of propofol may cause a large number of fatal cases. Therefore, nationwide establishment of a policy to prevent the spread of propofol abuse is urgently needed.
Cosmetics ; Dopamine ; Endoscopy, Gastrointestinal ; Hypnotics and Sedatives ; Propofol ; Republic of Korea ; Substance-Related Disorders

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Issues in procedural sedation outside the operating theater: characteristics and safety of commonly used sedatives and analgesics.

Young Chul YOO

Journal of the Korean Medical Association.2013;56(4):285-291. doi:10.5124/jkma.2013.56.4.285

With increasing interest towards the proper management of the patient's anxiety and pain during diagnostic and therapeutic procedures, adequate sedation has become an essential part of a successful procedure. Due to recent advancements in modern medicine, many surgical procedures that were once done under general anesthesia are being increasingly replaced by minimally invasive procedures that are performed under sedation. However, the duration or degrees of pain that are caused by different types of procedures vary extensively. Some procedures are easily done under only light sedation, while others require extensive pain control and deeper sedation. Comfort and safety are essential components of 'successful sedation', and full understanding of the degree of pain and the physiologic changes that the procedure may cause is needed in order to offer this to the patient. The depth of sedation should be controlled with proper sedatives while adequate analgesia should be offered according to type of procedure. Choice and doses of drugs should always be tailored to the patient's general condition, and additional administrations should be done after the effect of the previous dose is observed in order to avoid overdosing. When combining sedatives and/or analgesics, the possible synergistic effects between different drugs should always be kept in mind. In order to choose the adequate type and dose of drug, knowledge regarding the pharmacodynamic and pharmacokinetic properties of commonly used drugs for procedures is needed for safe and effective sedation.
Analgesia ; Analgesics ; Anesthesia, General ; Anxiety ; Conscious Sedation ; History, Modern 1601- ; Humans ; Hypnotics and Sedatives ; Light ; Patient Safety