TABLE 32 Monitoring and Rescusitation Equipment Required for Moderate Sedation

Procedure Room Immediately Accessible

Cardiac monitor Defibrillator

Pulse oximeter Emergency cart

Oxygen source Emergency drug box

Ambu bag with facemask Suction

Oral pharyngeal airway abuse. The time and nature of last oral intake is important and avoidance of fluids or solid foods for a sufficient period to allow for complete gastric emptying before the procedure (as recommended by the American Society of Anesthesiologists [ASA] "Guidelines for Preoperative Fasting") is essential and has potential medico-legal implications. In urgent, emergent situations, or situations in which gastric emptying is impaired, there is a potential for pulmonary aspiration. Consideration should be given to endotracheal intubation for airway protection in these patients.

Before initiating sedation for endoscopy, patients should have a focused physical examination, including vital signs, auscultation of the heart and lungs, and evaluation of the airway. The need for preprocedure laboratory testing will depend on the patient's underlying medical condition and the likelihood that the results will affect the management of sedation. Informed consent for the sedation and for the procedure should be obtained and witnessed.

Patients who are at increased risk for developing complications related to sedation should be identified. Special precautions are needed in patients with significant underlying medical conditions (eg, extremes of age; severe cardiac, pulmonary, hepatic, or renal disease; pregnancy; drug or alcohol abuse). In patients with significant sedation-related risks factors (eg, uncooperative patients, morbid obesity, potentially difficult airway, sleep apnea), a consultation with an anesthesiologist should be obtained. A useful medical risk classification system used universally by endoscopists is the ASA Physical Status Classification (Table 3-3).

Vascular access is required for all endoscopic procedures requiring sedation. It should be maintained throughout the procedure and until the patient is no longer at risk for cardiorespiratory depression.

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