Abstract
Many patients undergoing interventional techniques may require mild to moderate sedation, related to the nature of chronic pain and anxiety. Since the patient cannot communicate acute changes in symptoms, deep sedation and/or general anesthesia for most interventional procedures is considered as unsafe, thus resulting in increased morbidity and mortality, and creating compliance issues. For patients undergoing interventional pain procedures, sedation is a critical aspect and requires competence and defined standards of experience and expertise. Along with the monitoring standards established by the American Society of Anesthesiologists (ASA), including temperature, blood pressure, EKG, pulse oximetry, and quantitative end tidal CO2, other considerations are warranted by the anesthesiologist for a safe and successful procedure, including perioperative medications and fasting.
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References
Manchikanti L, Soin A, Mann DP, Bakshi S, Pampati V, Hirsch JA. Reversal of growth of utilization of interventional techniques in managing chronic pain in medicare population post affordable care act. rn [Internet]. 2017;20(7):551–67. Available from: http://www.ncbi.nlm.nih.gov/pubmed/29149139.
Manchikanti L, Soin A, Mann DP, Bakshi S, Pampati V, Hirsch JA. Comparative analysis of utilization of epidural procedures in managing chronic pain in the medicare population: pre and post affordable care Act. Spine (Phila Pa 1976) [Internet]. 2019;44(3):220–32. Available from: http://www.ncbi.nlm.nih.gov/pubmed/30005043.
Hirsch JA, Chandra RV, Pampati V, Barr JD, Brook AL, Manchikanti L. Analysis of vertebral augmentation practice patterns: a 2016 update. J Neurointerv Surg [Internet]. 2016;8(12):1299–304. Available from: http://www.ncbi.nlm.nih.gov/pubmed/27799375.
Lad SP, Babu R, Bagley JH, Choi J, Bagley CA, Huh BK, et al. Utilization of spinal cord stimulation in patients with failed back surgery syndrome. Spine (Phila Pa 1976) [Internet]. 2014;39(12):E719–27. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24718057.
​Statement on Anesthetic Care During Interventional Pain Procedures for Adults | American Society of Anesthesiologists (ASA).
Rathmell JP, Michna E, Fitzgibbon DR, Stephens LS, Posner KL, Domino KB. Injury and liability associated with cervical procedures for chronic pain. Anesthesiology [Internet]. 2011 Apr;114(4):918–26. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21386702.
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 [Internet]. 2006;104(2):228–34. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16436839.
Heran MKS, Smith AD, Legiehn GM. Spinal injection procedures: a review of concepts, controversies, and complications. Radiol Clin North Am [Internet]. 2008;46(3):487–514, v–vi. Available from: http://www.ncbi.nlm.nih.gov/pubmed/18707959.
Bartynski WS, Grahovac SZ, Rothfus WE. Incorrect needle position during lumbar epidural steroid administration: inaccuracy of loss of air pressure resistance and requirement of fluoroscopy and epidurography during needle insertion. AJNR Am J Neuroradiol [Internet]. 2005;26(3):502–5. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15760856.
Cucuzzella TR, Delport EG, Kim N, Marley J, Pruitt C, Delport AG. A survey: conscious sedation with epidural and zygapophyseal injections: is it necessary? Spine J [Internet]. 6(4):364–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16825040.
Epstein NE. Neurological complications of lumbar and cervical dural punctures with a focus on epidural injections. Surg Neurol Int [Internet]. 2017;8:60. Available from: http://www.ncbi.nlm.nih.gov/pubmed/28540126.
Elder BD, Goodwin CR, Abu-Bonsrah N, Sciubba DM. Intramedullary steroid injection of the cervical spine with incidental vertebral artery dissection. Spine J [Internet]. 2016;16(11):e725–6. Available from: http://www.ncbi.nlm.nih.gov/pubmed/27012650.
Lee J-H, Lee J-K, Seo B-R, Moon S-J, Kim J-H, Kim S-H. Spinal cord injury produced by direct damage during cervical transforaminal epidural injection. Reg Anesth Pain Med [Internet]. 33(4):377–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/18675752.
Kaye AD, Jones MR, Viswanath O, Candido KD, Boswell M V, Soin A, et al. ASIPP guidelines for sedation and fasting status of patients undergoing interventional pain management procedures. Pain Physician [Internet]. 2019;22(3):201–7. Available from: http://www.ncbi.nlm.nih.gov/pubmed/31151329.
The National Uniform Claims Committee. Specialty Designation for Interventional Pain Management- 09.
Medicare Payment Advisory Commission. 2001. Report to the Congress: Paying for interventional pain services in ambulatory settings 2001.
Manchikanti L, Abdi S, Atluri S, Benyamin RM, Boswell M V, Buenaventura RM, et al. An update of comprehensive evidence-based guidelines for interventional techniques in chronic spinal pain. Part II: guidance and recommendations. Pain Physician [Internet]. 2013;16(2 Suppl):S49–283. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23615883.
​Guidelines for Ambulatory Anesthesia and Surgery | American Society of Anesthesiologists (ASA).
American Society of Anesthesiologists (ASA). Statement on Nonoperating Room Anesthetizing Locations. Park Ridge, IL;
The Joint Commission. Accreditation Handbook for Office-Based Surgery: What You Need to Know About Obtaining Accreditation. [Internet]. [cited 2020 Mar 31]. Available from: www.jointcommission.org/assets/1/18/2011_OBS_Hdbk.pdf
​Basic Standards for PreAnesthesia Care | American Society of Anesthesiologists (ASA).
​Standards for Basic Anesthetic Monitoring | American Society of Anesthesiologists (ASA).
​Standards for Postanesthesia Care | American Society of Anesthesiologists (ASA).
​Guidelines for Office-Based Anesthesia | American Society of Anesthesiologists (ASA).
Ambulatory Health Care: 2020 National Patient Safety Goals | The Joint Commission.
Safety and Health Topics | Healthcare - Standards and Enforcement | Occupational Safety and Health Administration.
Kaye ADML. Interventional pain management procedures. In: Urman RDKA, editor. Moderate and deep sedation in clinical practice. 2nd ed. Cambridge: Cambridge University Press; 2017. p. 321–9.
(ASA). 1. American Society of Anesthesiologists. Advisory on Granting Privileges for Deep Sedation to Non-Anesthesiologist Physicians. Park Ridge, IL; 2010.
Practice Guidelines for Moderate Procedural Sedation and Analgesia 2018: A Report by the American Society of Anesthesiologists Task Force on Moderate Procedural Sedation and Analgesia, the American Association of Oral and Maxillofacial Surgeons, American. Anesthesiology [Internet]. 2018;128(3):437–79. Available from: http://www.ncbi.nlm.nih.gov/pubmed/29334501
​Continuum of Depth of Sedation: Definition of General Anesthesia and Levels of Sedation/Analgesia | American Society of Anesthesiologists (ASA).
Waugh JB, Epps CA, Khodneva YA. Capnography enhances surveillance of respiratory events during procedural sedation: a meta-analysis. J Clin Anesth [Internet]. 2011;23(3):189–96. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21497076.
​Statement on Qualifications of Anesthesia Providers in the Office-Based Setting | American Society of Anesthesiologists (ASA).
​Position on Monitored Anesthesia Care | American Society of Anesthesiologists (ASA).
Fu ES, Downs JB, Schweiger JW, Miguel RV, Smith RA. Supplement oxygen impairs detection of hypoventilation by pulse oximetry. Chest. 2004;
Das S, Ghosh S. Monitored anesthesia care: an overview. J Anaesthesiol Clin Pharmacol [Internet]. 31(1):27–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25788769.
American Society of Anesthesiologists Task Force on Intraoperative Awareness. Practice advisory for intraoperative awareness and brain function monitoring: a report by the american society of anesthesiologists task force on intraoperative awareness. Anesthesiology [Internet]. 2006;104(4):847–64. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16571982.
Vuyk J, Sitsen E, MR. Intravenous anesthetics. In: Gropper MA, Cohen NH, Eriksson LI, Fleisher LA, JPW-K KL, editors. Miller’s anesthesia. 9th ed. Philadelphia, PA: Elsevier; 2020. p. 638–79.
Arjun Reddy KM. Sedation in the endoscopy suite. In: Urman RDKA, editor. Moderate and deep sedation in clinical practice. 2nd ed. Cambridge: Cambridge University Press; 2017. p. 206–20.
Mark Shumacher KF. In: Gropper MA, Cohen NH, Eriksson LI, Fleisher LA, JPW-K KL, editors. Opioids, Miller’s anesthesia. 9th ed: Cambridge; 2020. p. 680–741.
Belleville JP, Ward DS, Bloor BC, Maze M. Effects of intravenous dexmedetomidine in humans. I. Sedation, ventilation, and metabolic rate. Anesthesiology [Internet]. 1992;77(6):1125–33. Available from: http://www.ncbi.nlm.nih.gov/pubmed/1361310.
Iannuccilli JD, Prince EA, Soares GM. Interventional spine procedures for management of chronic low back pain-A primer. Semin Intervent Radiol. 2013;
Post-Procedure Instructions | Pain Management | Dr. Dhanani.
Even JL, Crosby CG, Song Y, McGirt MJ, Devin CJ. Effects of epidural steroid injections on blood glucose levels in patients with diabetes mellitus. Spine (Phila Pa 1976). 2012;
Singh R, Panagos A. Quadriparesis following cervical epidural steroid injections. Spine J [Internet]. 6(3):349. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16651233.
Courington FW, Little DM. The role of posture in anesthesia. Clin Anesth 1968.
Pelosi P, Croci M, Calappi E, Cerisara M, Mulazzi D, Vicardi P, et al. The prone positioning during general anesthesia minimally affects respiratory mechanics while improving functional residual capacity and increasing oxygen tension. Anesth Analg. 1995;
Edrich T, Sadovnikoff N. Anesthesia for patients with severe chronic obstructive pulmonary disease. Curr Opin Anaesthesiol 2010.
Visser WA, Lee RA, Gielen MJM. Factors affecting the distribution of neural blockade by local anesthetics in epidural anesthesia and a comparison of lumbar versus thoracic epidural anesthesia. Anesthesia and Analgesia. 2008.
Lumb AB, Nunn JF. Respiratory function and ribcage contribution to ventilation in body positions commonly used during anesthesia. Anesth Analg. 1991;
Practice Guidelines for Sedation and Analgesia by Non-Anesthesiologists | Anesthesiology | ASA Publications.
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Southerland, W. et al. (2021). Sedation for Interventional Pain Procedures. In: Rajput, K., Vadivelu, N., Kaye, A.D., Shah, R.V. (eds) Pain Control in Ambulatory Surgery Centers. Springer, Cham. https://doi.org/10.1007/978-3-030-55262-6_17
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DOI: https://doi.org/10.1007/978-3-030-55262-6_17
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