Analysis of expert consultation referrals to the Korean Society of Anesthesiologists (KSA): a comparison of procedural sedation and general anesthesia
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
Procedural sedation during diagnostic or therapeutic procedures is currently widely used by clinicians across a broad range of specialties. However, procedural sedation is a poorly controlled practice in many countries, often performed in potentially unsafe environments.
In 2009, the Legislation Committee of the Korean Society of Anesthesiologists, based on expert consultation referrals provided by police departments, civil courts, and criminal courts, initiated the construction of database to compile all anesthesia-related adverse events. Using this database (July 2009 to April 2012), we have compared causative mechanisms and injury patterns in procedural sedation (Sedation) cases (N = 25) with those in general anesthesia (GA) cases (N = 29).
The severity of injury in Sedation cases was similar to that in GA cases, with death occurring in 72.0 % of cases. Hypoxia secondary to airway obstruction or respiratory depression was the most common specific mechanism of Sedation-related injuries (64.0 %). In-depth analysis of pre-procedural evaluation and intraoperative monitoring revealed a common lack of vigilance in the Sedation cases, and most injuries were judged as preventable with better monitoring. Non-anesthesiologist administration of propofol (NAAP) was performed in the great majority of Sedation cases (88.0 %).
Our analysis of procedural sedation based on anesthesia-related adverse events compiled in the national database revealed a high severity of patient injury similar to that due to general anesthesia. Most procedural sedations were shown to be poorly controlled without adequate pre-procedural patient evaluation or intraoperative monitoring. Thus, it is essential to establish proper practical guidelines for procedural sedation and ensure strict adherence to these guidelines, especially during the NAAP.
- Lee KH, An TH, Choi JH, Lim DG, Lee YJ, Kim DK. Analysis of expert consultation referrals for anesthesia-related issues (December 2008–July 2010): KSA legislation committee report. Korean J Anesthesiol. 2011;60:260–5. CrossRef
- Bhananker SM, Posner KL, Cheney FW, Caplan RA, Lee LA, Domino KB. Injury and liability associated with monitored anesthesia care: a closed claims analysis. Anesthesiology. 2006;104:228–34. CrossRef
- American Society of Anesthesiologists Task Force on Sedation and Analgesia by Non-Anesthesiologists. Practice guidelines for sedation and analgesia by non-anesthesiologists. Anesthesiology. 2002;96:1004–17.
- Green SM, Krauss B. Procedural sedation terminology: moving beyond “conscious sedation”. Ann Emerg Med. 2002;39:433–5. CrossRef
- American Society of Anesthesiology. Distinguishing monitored anesthesia care (“MAC”) from moderate sedation/analgesia (conscious sedation). Available at: http://www.asahq.org/For-Members/Standards-Guidelines-and-Statements.aspx. Accessed 4 Sept 2012.
- Perel A. Non-anaesthesiologists should not be allowed to administer propofol for procedural sedation: a Consensus Statement of 21 European National Societies of Anaesthesia. Eur J Anaesthesiol. 2011;28:580–4. CrossRef
- Hug CC Jr. MAC should stand for maximum anesthesia caution, not minimal anesthesiology care. Anesthesiology. 2006;104:221–3. CrossRef
- Godwin SA, Caro DA, Wolf SJ, Jagoda AS, Charles R, Marett BE, Moore J, American College of Emergency Physicians. Clinical policy: procedural sedation and analgesia in the emergency department. Ann Emerg Med. 2005;45:177–96. CrossRef
- Standards of Practice Committee of the American Society of Gastrointestinal endoscopy, Lichtenstein DR, Jagannath S, Baron TH, Anderson MA, Banerjee S, Dominitz JA, Fanelli RD, Gan SI, Harrison ME, Ikenberry SO, Shen B, Stewart L, Khan K, Vargo JJ. Sedation and anesthesia in GI endoscopy. Gastrointest Endosc. 2008;68:815–26. CrossRef
- Iverson RE. Sedation and analgesia in ambulatory settings. American Society of Plastic and Reconstructive Surgeons. Task Force on Sedation and Analgesia in Ambulatory Settings. Plast Reconstr Surg. 1999;104:1559–64. CrossRef
- Eichhorn V, Henzler D, Murphy MF. Standardizing care and monitoring for anesthesia or procedural sedation delivered outside the operating room. Curr Opin Anaesthesiol. 2010;23:494–9. CrossRef
- Downs JB. Has oxygen administration delayed appropriate respiratory care? Fallacies regarding oxygen therapy. Respir Care. 2003;48:611–20.
- Dinis-Ribeiro M, Vargo JJ. Sedation by non-anesthesiologists: are opioids and benzodiazepines outdated? Digestion. 2010;82:100–1. CrossRef
- Coté GA. The debate for nonanesthesiologist-administered propofol sedation in endoscopy rages on: who will be the “King of Prop?”. Gastrointest Endosc. 2011;73:773–6. CrossRef
- Rex DK, Deenadayalu VP, Eid E, Imperiale TF, Walker JA, Sandhu K, Clarke AC, Hillman LC, Horiuchi A, Cohen LB, Heuss LT, Peter S, Beglinger C, Sinnott JA, Welton T, Rofail M, Subei I, Sleven R, Jordan P, Goff J, Gerstenberger PD, Munnings H, Tagle M, Sipe BW, Wehrmann T, Di Palma JA, Occhipinti KE, Barbi E, Riphaus A, Amann ST, Tohda G, McClellan T, Thueson C, Morse J, Meah N. Endoscopist-directed administration of propofol: a worldwide safety experience. Gastroenterology. 2009;137:1229–37. CrossRef
- Werner C, Smith A, Van Aken H. Guidelines on non-anaesthesiologist administration of propofol for gastrointestinal endoscopy: a double-edged sword. Eur J Anaesthesiol. 2011;28:553–5. CrossRef
- Localio AR, Lawthers AG, Brennan TA, Laird NM, Hebert LE, Peterson LM, Newhouse JP, Weiler PC, Hiatt HH. Relation between malpractice claims and adverse events due to negligence. Results of the Harvard Medical Practice Study III. N Engl J Med. 1991;325:245–51. CrossRef
- Jordan LM, Kremer M, Crawforth K, Shott S. Data-driven practice improvement: the AANA Foundation closed malpractice claims study. AANA J. 2001;69:301–11.
- Bogod D. Negligence litigation and medicine: force for good or root of all evil. Anaesthesia. 2011;66:247–9. CrossRef
- Analysis of expert consultation referrals to the Korean Society of Anesthesiologists (KSA): a comparison of procedural sedation and general anesthesia
Journal of Anesthesia
Volume 27, Issue 2 , pp 218-223
- Cover Date
- Print ISSN
- Online ISSN
- Springer Japan
- Additional Links
- Deep sedation
- Industry Sectors
- Author Affiliations
- 1. Department of Anesthesiology and Pain Medicine, Yeouido St. Mary’s Hospital, School of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- 2. Department of Anesthesiology and Pain Medicine, Saint Vincent’s Hospital, School of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- 3. Department of Anesthesiology and Pain Medicine, School of Dentistry, Kyungpook National University, Daegu, Republic of Korea
- 4. Department of Anesthesiology and Pain Medicine, Chonbuk National University Medical School, Jeonju, Republic of Korea
- 5. Department of Anesthesiology and Pain Medicine, Inha University School of Medicine, Incheon, Republic of Korea
- 6. Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-Dong, Gangnam-Gu, Seoul, 135-710, Republic of Korea