Procedural Sedation

Procedural sedation is the administration of sedative, analgesic, and/or dissociative agents to induce a state that allows the patient to tolerate unpleasant procedures while maintaining cardiorespiratory function. The sedation continuum ranges from minimal sedation (anxiolysis) through moderate sedation (conscious sedation — purposeful response to verbal or light tactile stimulation) to deep sedation (response only to painful stimulation) and general anesthesia (unarousable). The ASA classification guides patient selection: ASA I-II patients are appropriate for NP-administered sedation; ASA III-IV require anesthesiology consultation. Common agents include: propofol (rapid onset/offset, no analgesic properties), ketamine (dissociative — maintains airway reflexes and hemodynamics, provides analgesia), midazolam (benzodiazepine anxiolytic), fentanyl (short-acting opioid), and etomidate (ultrashort-acting, hemodynamically neutral). The NP must be prepared to rescue from a deeper level of sedation than intended — if targeting moderate sedation, must be competent to manage deep sedation complications including airway obstruction and apnea.