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Deep Sedation

Deep sedation is a state of depressed consciousness where patients respond only to painful stimuli.
It is achieved through the administration of sedative medications and may be used in various medical and surgical procedures to ensure patient comfort and compliance.
This state is deeper than moderate sedation, where patients respond to verbal commands, and is often accompanied by the need for airway support and monitoring of vital signs.
Proper management of deep sedation is crucial to maintain patient safety and minimize risks such as respiratory depression, hypotension, and other adverse events.
Clinicians should be trained in the appropriate use and monitoring of deep sedation techniques to optimize patient outcomes and experience the full benefits of this important medical intervention.

Most cited protocols related to «Deep Sedation»

1
Sedation Practices and Outcomes in ICU
Cited 8 times
Baseline data included demographics, co-morbidities, vital signs, and laboratory variables. ED processes of care included length of stay, transfusion, antibiotic administration, central venous catheter placement, and vasopressor infusion.
Sedation-related data in the ED included neuromuscular blockers and induction agents for intubation. Subsequent medications related to ED analgesia and sedation included opiates, benzodiazepines, propofol, ketamine, dexmedetomidine, etomidate, haloperidol, quetiapine, and neuromuscular blockers.
Sedation depth in the ED was recorded. Given the pragmatic intent of the study and equivalence between scales, sedation depth was monitored according to standard operating procedures at each site [15 (link)]. This included the Richmond Agitation-Sedation Scale (RASS; deep sedation defined as score of −3 to −5), or the Riker Sedation-Agitation Scale (SAS; deep sedation defined as score of 2 or 1) [15 (link)]. When more than one sedation depth per patient was documented, the median value was used. In patients for whom no ED sedation depth was documented, the first ICU sedation depth was used as a surrogate, congruent with prior approach [11 (link)]. We anticipated that some EDs may not routinely monitor sedation depth for mechanically ventilated patients, as ED-based sedation has not received clinical or research focus. In that situation, a documented GCS was used as a surrogate for sedation depth (≤ 9 defined as deep sedation) [16 ].
Agents administered for analgesia and sedation during the first 48 hours of ICU admission were collected. Patients were followed until hospital day 28 or death. The primary outcome was ventilator-free days. Secondary outcomes included acute brain dysfunction during the first 48 hours after admission, mortality, ICU-, and hospital-free days. Acute brain dysfunction is a composite of delirium and coma [17 (link)]. Delirium was assessed with the Confusion Assessment Method for the ICU (CAM-ICU) per institutional protocols. Coma was defined as being unresponsive or responsive only to physical stimulus (i.e. RASS −4 or −5) with every measurement of sedation depth [17 (link), 18 (link)].
Fuller B.M., Roberts B.W., Mohr N.M., Knight WA I.V., Adeoye O., Pappal R.D., Marshall S., Alunday R., Dettmer M., Goyal M., Gibson C., Levine B.J., Gardner-Gray J.M., Mosier J., Dargin J., Mackay F., Johnson N.J., Lokhandwala S., Hough C.L., Tonna J.E., Tsolinas R., Lin F., Qasim Z.A., Harvey C.E., Bassin B., Stephens R.J., Yan Y., Carpenter C.R., Kollef M.H, & Avidan M.S. (2019). The ED-SED Study: a multicenter, prospective cohort study of practice patterns and clinical outcomes associated with Emergency Department SEDation for mechanically ventilated patients. Critical care medicine, 47(11), 1539-1548.
Publication 2019
Antibiotics Benzodiazepines Blood Transfusion Brain Comatose Deep Sedation Delirium Dexmedetomidine Etomidate Haloperidol Intubation Ketamine Management, Pain Neuromuscular Blocking Agents Opiate Alkaloids Patients Pharmaceutical Preparations Physical Examination Propofol Quetiapine rasagiline Signs, Vital Vasoconstrictor Agents Venous Catheter, Central
2
Neural Correlates of Sedation Levels
Cited 8 times

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Publication 2016
Anesthesiologist Anesthetics Blood Pressure Carbon dioxide Deep Sedation ECHO protocol Electrocardiography Females fMRI Head Healthy Volunteers Human Body Index, Body Mass Lethargy Light Males Nasal Cannula Oximetry, Pulse Oxygen Plasma Propofol Radionuclide Imaging Sedatives Wakefulness
3
Assessing Delirium using RASS in ED Patients
Cited 6 times
The RASS is an arousal scale commonly used in intensive care units to assess for depth of sedation (Figure 1),10 (link) but has been incorporated into several delirium assessments to assess for level of consciousness.6 (link) For this study, we replaced the term “sedation” with “drowsy,” (Figure 1) to describe level of consciousness regardless of sedation administration. A RASS of 0 represented normal level of consciousness whereas a RASS other than 0 represented the presence of altered level of consciousness. The RASS was determined by an emergency physician (EP) and research assistants (RAs; college graduates, emergency medical technicians, and paramedics). Before the study began, the RAs were given a 5-minute didactic lecture about the RASS. The principal investigator then observed them perform the RASS in five older ED patients and provided them instruction if there was any discordance.
The reference standard assessment for delirium was performed by one of three consultation-liaison psychiatrists who diagnose delirium as part of their routine clinical practice. They had an average of 11 years of clinical experience. Their assessment was based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision criteria (DSM-IV-TR).11 Details of their assessment have been described in previous reports.6 (link) Briefly, they used all means of patient evaluation and testing, as well as data gathered from those who best understand the patient’s current mental status (e.g., the patient’s surrogates, physicians, and nurses). They performed a battery of cognitive tests, a focused neurological examination, and evaluated each patient for affective lability, hallucinations, and arousal level as part of their evaluations.
Once a patient was enrolled and consented, the RA and EP assessed the patient’s RASS at the same time, but their assessments were blinded to each other. This method of reliability testing was performed to minimize any discrepancies that may have occurred as a result of time, especially since level of consciousness can fluctuate rapidly. The research raters and psychiatrists were also blinded to each other, and all assessments were performed within 3 hours of each other. Medical record review was performed after the patient was enrolled to determine dementia status. Dementia was defined as the presence of this diagnosis in medical record documentation or use of a cholinesterase inhibitor.
Han J.H., Vasilevskis E.E., Schnelle J.F., Shintani A., Dittus R.S., Wilson A, & Ely E.W. (2015). The Diagnostic Performance of the Richmond Agitation Sedation Scale for Detecting Delirium in Older Emergency Department Patients. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, 22(7), 878-882.
Publication 2015
Arousal Cholinesterase Inhibitors Cognitive Testing Consciousness Deep Sedation Delirium Diagnosis Emergencies Emergency Medical Technicians Hallucinations Neurologic Examination Nurses Paramedical Personnel Patients Physicians Presenile Dementia Psychiatrist ras Oncogene Respiratory Diaphragm Sedatives Somnolence
4
Resting-state fMRI Under Propofol Sedation
Cited 5 times
Having obtained local ethics permission from the Cambridgeshire 2 Regional ethics committee and written consent from participants we acquired resting state fMRI (150 volumes of BOLD data, 5 minutes, TR = 2 s) from a group of 16 adults, 19–52 years old (mean = 34.62, standard deviation = 9.05). During scanning we instructed volunteers to close their eyes and think about nothing in particular throughout the acquisition of the resting state BOLD data.
Volunteers were informed of the risks of propofol administration, such as loss of consciousness, respiratory and cardiovascular depression. They were also informed about more minor effects of propofol such as pain on injection, sedation and amnesia. In addition, standard information about intravenous cannulation, blood sampling and MRI scanning was provided.
Propofol was administered using a computer controlled intravenous infusion [32] (link), [33] (link) aiming to achieve three target plasma levels - no drug (awake), 0.6 µg/ml (low sedation) and 1.2 µg/ml (moderate sedation). At regular intervals between scans, depth of sedation was evaluated by assessing the responsiveness of volunteers to verbal instructions and formally recorded as OAA/S scores. In all volunteers two blood samples (2×1 ml) were taken at each sedation level for later measurement of plasma propofol concentrations with high performance liquid chromatography (HPLC).
The reasons why we chose to use fixed target concentrations, rather than titration of propofol dose to a sedation score, are as follows. All clinical sedation scales suffer from several weaknesses - they are highly subjective, and some of the commonly used scales, such as the Ramsay scale [62] (link) suffer from significant inter-rater variability [63] (link). In addition most clinical sedation scales were designed for a different population than the one in our study. For example, the Ramsay scale, commonly used in sedation studies, was designed for agitated and anxious critically ill patients in an intensive care environment. The Observer's Assessment of Alertness/Sedation Scale (OAA/S) [64] (link) is less well-known outside of the anesthesiology literature, but is more applicable to sedated healthy controls. Finally, sedation scores (including the OAA/S) correlate very poorly with objective EEG-based measures of sedation such as the Bispectral Index and state entropy [65] (link), [66] (link). Nonetheless, in order to provide comparability with previous studies, we recorded data on sedation scores in all subjects.
During data collection there were always two trained anesthesiologists present, and observed the volunteer from the MRI control room and on a video link that showed the volunteer in the scanner. In addition, heart rate, electrocardiogram (ECG) and pulse oximetry were continuously monitored using an MR-compatible multiparameter monitor (Precess, InVivo Corp., Orlando, FL, USA). Non-invasive systemic blood pressure was measured intermittently during the study, but was suspended during scanning.
Stamatakis E.A., Adapa R.M., Absalom A.R, & Menon D.K. (2010). Changes in Resting Neural Connectivity during Propofol Sedation. PLoS ONE, 5(12), e14224.
Publication 2010
Adult Amnesia Anesthesiologist BLOOD Cannulation Cardiovascular System Conscious Sedation Critical Illness Debility Deep Sedation Electrocardiography Entropy Eye fMRI High-Performance Liquid Chromatographies Intensive Care Intravenous Infusion Oximetry, Pulse Pain Patients Pharmaceutical Preparations Plasma Propofol Rate, Heart Regional Ethics Committees Respiratory Rate Sedatives Titrimetry Voluntary Workers
5
Ventilator-Free Days in ED Sedation
Cited 4 times
Patient characteristics were assessed with descriptive statistics and frequency distributions. Categorical characteristics were compared using chi-square test or Fisher’s exact test. Continuous characteristics were compared using independent samples t-test or Mann-Whitney U test.
The primary analysis examined ventilator-free days as a function of ED sedation depth. A multivariable linear regression model was constructed to adjust for potentially confounding variables using backward elimination. A priori baseline characteristics with known prognostic significance for mortality in ED mechanically ventilated patients were purposefully selected for model inclusion (age, indication for mechanical ventilation, tidal volume, illness severity). Other clinically relevant and biologically plausible variables significant in univariate analysis at a p < 0.10 level were also included in the model. Collinearity was assessed and the model used variables that were independent of other variables. All tests were two-tailed, and a p value < 0.05 was considered statistically significant.
From prior work regarding early deep sedation in the ICU and ED, we assumed a difference in mean ventilator-free days of 2.5 between groups. For 80% power and α of 0.05, we estimated a sample size of 324 patients (162 per group) would be required [8 (link), 9 , 11 (link), 14 ].
Fuller B.M., Roberts B.W., Mohr N.M., Knight WA I.V., Adeoye O., Pappal R.D., Marshall S., Alunday R., Dettmer M., Goyal M., Gibson C., Levine B.J., Gardner-Gray J.M., Mosier J., Dargin J., Mackay F., Johnson N.J., Lokhandwala S., Hough C.L., Tonna J.E., Tsolinas R., Lin F., Qasim Z.A., Harvey C.E., Bassin B., Stephens R.J., Yan Y., Carpenter C.R., Kollef M.H, & Avidan M.S. (2019). The ED-SED Study: a multicenter, prospective cohort study of practice patterns and clinical outcomes associated with Emergency Department SEDation for mechanically ventilated patients. Critical care medicine, 47(11), 1539-1548.
Publication 2019
Deep Sedation Mechanical Ventilation Patients Tidal Volume

Most recents protocols related to «Deep Sedation»

1
Anesthetic Management Trends in TAVR
The variable of interest was primary anesthetic management type, and we specifically compared general anesthesia to monitored anesthesia care. We combined the variable “conscious sedation”, which was a less precise “catchall” data field used prior to 2016 when NACOR data was compiled largely based on local definitions, and “monitored anesthesia care”, which became the standard terminology adopted in 2017 when the AQI released standardized data definitions. The AQI's current definition of monitored anesthesia care is, “A specific type of anesthesia service in which a qualified anesthesia provider has been requested to participate in the care of a patient undergoing a diagnostic or therapeutic procedure. Indications for monitored anesthesia care depend on the nature of the procedure, the patient's clinical condition, and/or the potential need to convert to a general or regional anesthetic. Deep sedation/analgesia is also included in monitored anesthesia care.”[16 ] Thus, according to the ASA's Standards and Guidelines, monitored anesthesia care does not necessarily denote the continuum of depth of sedation; rather, monitored anesthesia care may include minimal sedation anxiolysis, moderate sedation/analgesia (”conscious sedation”), or deep sedation/analgesia in which qualified anesthesia personnel have been requested to participate in the care of a patient undergoing a diagnostic or therapeutic procedure.
We evaluated the frequency of use of each of the two anesthesia management types over time. Cochran-Armitage testing was used to determine whether or not the trends were statistically significant. We used multivariable logistic regression model to evaluate patient, hospital, and procedural characteristics to identify variables associated with the primary outcome. We did not use variables that had rates of missing data >10%. Other variables were either imputed to the mode, median, or complete case analysis was used. Investigators selected factors based on clinical and theoretical reasoning. The models were adjusted for age, sex, race, ASA physical status, US census region in which a center is located, procedural approach, median income by patient zip code, and center volume of transcatheter aortic valve replacements. Volume of transcatheter aortic valve replacements was calculated as the total number of all transcatheter aortic valve replacements for each practice during each year for our study period. In order to account for practice level variation, we used three-level hierarchical modeling and nested patients within practices within each year to properly generate our variance estimates. Model fit was assessed using C-statistic, Hosmer-Lemeshow test, as well as a model calibration plot. Continuous variables were presented as medians (interquartile range, 25th and 75th percentile) and differences across anesthesia type were assessed using Mann-Whitney U tests. Categorical variables were presented as counts (proportions) and differences across anesthesia type were assessed using the Chi-square test.
The secondary outcome was case duration in minutes, defined as duration in minutes from the recorded anesthesia start to anesthesia finish. Based on the distribution of this outcome, we excluded cases with duration less than or equal to 60 min as this was considered to be the lower 1% and deemed unlikely to be realistic. Additionally, in order to account for the skewed nature of the data, we log-transformed the outcome. We fit a multivariable linear model to assess the association between anesthesia management type and case duration. We also utilized the same three-level hierarchical structure as described above, also adjusting for the same covariates. All statistics were performed using SAS v 9.4 (SAS, Cary, NC).
Hayanga H.K., Woods K.E., Thibault D.P., Ellison M.B., Boh R.N., Raybuck B.D., Sengupta P.P., Badhwar V, & Awori Hayanga J.W. (2023). Anesthetic Management for Transcatheter Aortic Valve Replacement: A National Anesthesia Clinical Outcomes Registry Analysis. Annals of Cardiac Anaesthesia, 26(1), 29-35.
Publication 2023
Anesthesia Anesthetics Anti-Anxiety Agents Conscious Sedation Deep Sedation Diagnosis General Anesthesia Local Anesthesia Management, Pain Patients Physical Examination Sedatives Therapeutics Training Programs Transcatheter Aortic Valve Replacement
2
Standardized Catheter Ablation Protocol for Atrial Fibrillation
In all procedures, deep sedation with midazolam, fentanyl, and propofol was used. Left atrial thrombus formation was ruled out prior to the procedure. After application of local anesthesia, the right femoral vein was accessed with three 8 F introducer sheaths. The left atrium (LA) was accessed using a transseptal approach via a steerable sheath (Agilis; Abbott, Abbott Park, North Chicago, Illinois, USA). In case of double transseptal puncture, an 8.5 F SL1 sheath (Abbott, Abbott Park, North Chicago, Illinois, USA) and a modified Brockenbrough technique were used to access the LA. Afterwards, a predefined heparin bolus was applied. Activated clotting time (ACT) was assessed every 15 min throughout the procedures, and heparin was repeatedly administered to maintain an ACT of 300–350 s. A decapolar diagnostic catheter was placed into the coronary sinus.
The DT catheter was used in all procedures and connected to the EnSite X system as demonstrated in Figures 1 and 2. In all procedures, three-dimensional (3D) electroanatomical mapping was performed using the EnSite X mapping system in NavX mode together with a multipolar mapping catheter (Advisor FL SE or Advisor HD Grid SE; Abbott Laboratories, Abbott Park, North Chicago, Illinois, USA). Procedural data were logged using the electrophysiological (EP) recording system (CardioLab, General Electric, Boston, USA). In all index PVI procedures, a paired, antral, ipsilateral PVI was performed in a point-by-point fashion (Fig. 3). Prior to ablation, each pulmonary vein (PV) ostium was carefully registered in the 3D-mapping system after selective angiography. A temperature-controlled mode was used with a maximum tolerated temperature of 60°C. Maximum output power was set to 50 W. In case of repeat procedures, ablation beyond PVI was carried out at the operator’s discretion focusing on substrate modification based on bipolar low-voltage mapping in sinus rhythm (Fig. 4).
No esophageal temperature measurement was used because this was not part of our institutional ablation protocol.
Sohns C., Fink T., Bergau L., Braun M., El Hamriti M., Sciacca V., Guckel D., Khalaph M., Imnadze G, & Sommer P. (2023). First clinical experience using the DiamondTemp catheter and a novel omnipolar high-resolution mapping system for atrial fibrillation ablation. Cardiology Journal, 30(1), 36-43.
Publication 2023
Angiography Antral Atrium, Left Catheters Deep Sedation Diagnosis Electricity Fentanyl Heparin Local Anesthesia Midazolam Propofol Punctures Sinus, Coronary Sinuses, Nasal Thrombus Vein, Femoral Veins, Pulmonary
3
Sedated MRI Neuroimaging Protocol
All subjects underwent MRI examination on a GE Signa HDxT 1.5T MRI scanner with a dedicated eight-channel head and neck unite coil. Ten percent chloral hydrate (0.5 mL/kg) was administered via anal enema for sedation 30 min before examination. MRI scanning was performed during the deep sedation. The imaging protocol included axial T1WI (TR = 2950 ms, TE = 25 ms, slice thickness = 4 mm, matrix = 288 × 192, NEX = 2, FOV = 22.0 × 22.0 cm).
Yu J., Liu Y., Jiang Y., Gao B., Wang J., Guo Y., Xie L, & Miao Y. (2023). Development and evaluation clinical-radiomics analysis based on T1-weighted imaging for diagnosing neonatal acute bilirubin encephalopathy. Frontiers in Neurology, 14, 956975.
Publication 2023
Anus Deep Sedation Enema Head Hydrate, Chloral Neck Sedatives Unite resin
4
Monitoring Pediatric Sedation Depth
To measure the depth of sedation in patients, a pediatric BIS™ sensor and a BIS™ Model A-2000 monitor (Covidien, Mansfield, MA, USA) were used.
Through the sensor placed on the patient’s forehead, electroencephalogram (EEG) information was obtained. The BIS system processes the EEG information and calculates a number between 0 and 100 corresponding to a direct measurement of the patient’s level of consciousness and their response to sedation. A BIS value close to 100 indicates that the patient is awake, while a BIS value of 0 indicates the absence of brain electrical activity. BIS values between 40 and 60 indicate deep sedation (Aspect Medical System, Norwood, MA, USA).
Flores-Pérez C., Flores-Pérez J., Moreno-Rocha L.A., Chávez-Pacheco J.L., Noguez-Méndez N.A., Ramírez-Mendiola B., Sánchez-Maza Y, & Sarmiento-Argüello L. (2023). Influence of Age and Sex on the Pharmacokinetics of Midazolam and the Depth of Sedation in Pediatric Patients Undergoing Minor Surgeries. Pharmaceutics, 15(2), 440.
Publication 2023
Brain Consciousness Deep Sedation Electricity Electroencephalography Forehead Patients Sedatives
5
Piglet Growth and Metabolic Profile
Body weight (BW) of the piglets was measured on days 1, 3, 6, 13, 20, 27, 30 and 34 of life. In each of the two replicate batches, blood samples were collected from ten piglets each at day of life 7, 14, 21, 31 and 35. On each of the five sampling days, five piglets per diet and sex were selected based on average body weight development across litters. Blood was taken from the heart on days 7, 14, 21, 28, 31 and 35 of life after deep sedation of the piglets (Stresnil 40 mg/mL, 0.025 mL/kg body weight, Azaperone, Elanco Tiergesundheit AG, Basel, Switzerland and Narketan 100 mg/mL, 0.1 mL/kg body weight, Ketamine, Vetoquinol Österreich GmbH, Vienna, Austria). The blood was collected into plasma and serum tubes (Vacuette Röhrchen K3E K3EDTA and Vacuette Röhrchen CAT Serum, Greiner Bio-One International GmbH, Kremsmünster, Austria) for metabolomics and clinical biochemistry, respectively. After inverting the blood tubes, they were stored on crash ice until centrifugation at 3000× g for 20 min at 4 °C (Eppendorf Centrifuge 5810 R, Eppendorf, Hamburg, Germany). Serum and plasma were aliquoted and stored at −80 °C until analysis.
Metzler-Zebeli B.U., Lerch F., Yosi F., Vötterl J.C., Koger S., Aigensberger M., Rennhofer P.M., Berthiller F, & Schwartz-Zimmermann H.E. (2023). Creep Feeding and Weaning Influence the Postnatal Evolution of the Plasma Metabolome in Neonatal Piglets. Metabolites, 13(2), 214.
Publication 2023
Azaperone BLOOD Body Weight Centrifugation Deep Sedation Diet DNA Replication Heart Ketamine Patient Holding Stretchers Plasma Serum Stresnil

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More about "Deep Sedation"

Deep sedation, also known as general anesthesia, is a state of profound unconsciousness where patients are unresponsive to even painful stimuli.
This level of sedation is often achieved through the administration of potent sedative medications, such as propofol, dexmedetomidine, or a combination of drugs.
Deep sedation is commonly utilized in various medical and surgical procedures, including endoscopic procedures (e.g., GIF-H260Z, EchoTip ProCore, Echotip), cardiac ablation (e.g., CARTO 3, GF-UCT260), and other interventional therapies (e.g., FlexCath Advance, GF-UCT180).
Maintaining patient safety during deep sedation is crucial, as it is accompanied by the need for airway support and continuous monitoring of vital signs.
Clinicians trained in the appropriate use and monitoring of deep sedation techniques, such as the Jagwire guidewire, are essential to optimize patient outcomes and minimize the risks of respiratory depression, hypotension, and other adverse events.
Deep sedation, when properly managed, can ensure patient comfort, compliance, and the successful completion of complex medical procedures.
By unlocking the potential of AI-driven protocol comparison, researchers can identify the best sedation practices from the literature, pre-prints, and patents, leading to more reproducible science and optimized experimental workflows.