Moderate Sedation

Hey guys!  Today I want to talk to you about moderate sedation in the operating room!

So what is moderate sedation?  Moderate sedation is a process where medication is given usually IV to a patient to put them in a state where their consciousness is mildy depressed, so that they can tolerate a procedure or surgery comfortably.  It is important to know and recognize that the patient is responsible for protecting their own airway and reflexes, they have an altered perception of pain, and they often can’t remember the specifics of the procedure afterwards….which is a good thing!  Be sure to check out the additional lessons we have on general and local anesthesia!

So before we dig in deeper to moderate sedation I want to mention that sometimes the RN administers the moderate sedation.  Be sure to consult your state board of nursing to verify your scope of practice!

So moderate sedation medications are typically sedatives, analgesics (pain meds), or a combination of both.  A few common sedatives are propofol which is that milky looking medication and versed. A few pain meds that are used are morphine and fentanyl and ketamine has both sedative and analgesic properties.

So when administering medications for sedation and pain we need to be able to reverse the medications if they get too much, because remember these patients have to breathe on their own.  So if a patient gets too much of an opioid like morphine they can be reversed with Narcan which is an opioid antagonist. And if a patient receives too much of a sedative like Versed a benzodiazepine receptor antagonist like Romazicon can be used to reverse these effects.

Ok so what do we need to assess in our patients who will be receiving moderate sedation?  Take a look at their allergies for any contraindications, age and BMI because advanced age and elevated BMI can make ventilation difficult if ventilation of the patient becomes necessary.  Also tobacco, alcohol, and drug abuse can increase the medication needs to keep the patient in a sedated state. Be sure to have vital signs pre-procedure so you have data to compare with during the procedure.

Continuing with assessment of the patient before moderate sedation assess the patient for possible obstructive sleep apnea.  Obstructive sleep apnea is a sleep disorder that causes obstruction of the airway. Why is this important? Remember the patient must maintain their own airway so we need to know if they have any history of this issue or have risk factors like obesity, a family history, or enlarged tonsils.

Assess your patient for ventilation issues….would you be able to ventilate your patient if necessary?  Remember sedation decreases the effort of breathing in the patient. Advanced age, elevated BMI, thick neck, limited neck extension, and missing teeth are all risk factors that can make ventilation more difficult.

Ok so what do we monitor when the patient is under moderation sedation?  Blood pressure, ECG, respiratory rate, oxygen saturation, sedation level or Bispectral index (BIS) which you can see in the picture and level of consciousness are all monitored.  Check your facility policy for the timing of monitoring typically we check these things every five minutes.

So an additional monitoring technique is capnography which measures the patient’s CO2 levels.   This is important because if the patient is poorly ventilated they will retain CO2, high CO2 equals hypercarbia in the patient which can lead to acidosis and eventually respiratory arrest.  So as you can see making sure the patient is ventilating themselves properly is super important!

Ok guys what do we teach the patient who will undergo moderate sedation?  Teach the patient the sequence of events, what will happen before, during, and after the sedation.  It’s super important that the patient knows they can not drive after sedation! Teach the patient to follow all instructions so their procedure goes as planned!  And as always teach your patient to ask questions!

Ok guys a few nursing concepts that can be applied to moderate sedation.  Comfort and safety both apply as the purpose of moderate sedation is to help the patient through a procedure comfortably and safely.  We use clinical judgement with moderate sedation as the perioperative RN is responsible for the patient’s sedation level.

Ok some key points for moderate sedation!  Moderate sedation is a drug induced state we place patients in so that they can withstand a procedure comfortably.  Remember the patient has to protect their own airway, they breathe on their own but they have an altered perception of pain and some amnesia.  In some facilities and states the RN administers moderate sedation, check your state board of nursing! Common medications are sedatives like propofol and versed, analgesics like morphine and fentanyl.  Assess your patient for allergies, obstructive sleep apnea, ventilation ability, current medications, and tobacco, alcohol and drug use. Monitor the patient’s BP, respiratory rate, oxygen saturation, CO2 levels, sedation level and level of consciousness.   Teach your patient the sequence of events before, during, and after the sedation, teach the patient to follow instructions and ask questions!

Okay guys I hope you enjoyed this lesson on moderate sedation!  Make sure you check out all the resources attached to this lesson, as well as the rest of the lessons in this course. Now, go out and be your best self today. And, as always, happy nursing!