'$ 3) A post-anesthesia note is completed by an Anesthesia provider for all patients who Sedation for upper endoscopy: Comparison of midazolam. Patients whose only response is reflex withdrawal from painful stimuli are deeply sedated, approaching a state of general anesthesia, and should be treated accordingly. Presurgical Functional MappingAndrew C. Papanicolaou, Roozbeh Rezaie, Shalini Narayana, Marina Kilintari, Asim F. Choudhri, Frederick A. Boop, and James W. Wheless, the Child With SeizureDon K. Mathew and Lawrence D. Morton, Hematology, Oncology and Palliative Medicine, 51. The use of flumazenil to reverse diazepam sedation after endoscopy. Nancy has been a . Sixth, the consultants were surveyed to assess their opinions on the feasibility of implementing the guidelines. Nasal oxygen alleviates hypoxemia in colonoscopy patients sedated with midazolam and meperidine. The design, equipment and staffing of the PACU shall meet requirements of the facilitys accrediting and licensing bodies. Fast-tracking: an action bypassing PACU phase I recovery when phase I criteria have been met before leaving the operating room (OR). The authors declare no competing interests. Reflector Series 1. After sedation/analgesia, observe and monitor patients in an appropriately staffed and equipped area until they are near their baseline level of consciousness and are no longer at increased risk for cardiorespiratory depression, Monitor oxygenation continuously until patients are no longer at risk for hypoxemia, Monitor ventilation and circulation at regular intervals (e.g., every 5 to 15min) until patients are suitable for discharge, Design discharge criteria to minimize the risk of central nervous system or cardiorespiratory depression after discharge from observation by trained personnel####. The Perianesthesia RN#s scope includes, but is not limited to, the preadmission assessment/process, Post Anesthesia Care Unit (Phase 1), Phase 2 recovery/discharge. Capnography is superior to pulse oximetry for the detection of respiratory depression during colonoscopy. d. Physician evaluation is used in place of discharge criteria or discharge score. 3. Differ from previous guidelines in that they were developed by a multidisciplinary task force of physicians from several medical and dental specialty organizations with the intent of specifically addressing moderate procedural sedation provided by any medical specialty in any location. What Age Is Considered Elderly? A single dose of propofol can produce excellent sedation and comparable amnesia with midazolam in cystoscopic examination. Moderate and deep sedation or general anesthesia may be achieved via any route of administration. Able to breathe deeply and cough freely, g. Dyspnea, limited breathing, or tachypnea. Ineffective ventilation during conscious sedation due to chest wall rigidity after intravenous midazolam and fentanyl. Standard V.1. "tN[(gk40=s\,.nv/+|A@06 dP3;=8d$sHpp The consultants, ASA members, AAOMS members, and ASDA members strongly agree with the recommendation that combinations of sedative and analgesic agents may be administered as appropriate for the procedure and the condition of the patient. All patients who receive anesthesia care shall be admitted to the PACU or its equivalent except by specific order of the anesthesiologist responsible for the patients care. sIm;O@=@ Ensure standard of care is met for all patients. Literature comparing propofol with other sedative/analgesic medications, either alone or in combination, report the following findings: (1) Meta-analysis of RCTs report faster recovery times for propofol versus midazolam after procedures with moderate sedation (category A1-B evidence),9599 with equivocal findings for patient recall,95,100103 and frequency of hypoxemia (category A1-E evidence).96,100,102,103 One RCT reports shorter sedation time, a lower frequency of recall and higher recovery scores for propofol versus diazepam (category A3-B evidence).104 (2) RCTs comparing propofol versus benzodiazepines combined with opioid analgesics report shorter sedation and recovery times for propofol alone (category A2-B evidence),105,106 with equivocal findings for pain, oxygen saturation levels, and blood pressure (category A2-E evidence).107109 (3) RCTs comparing propofol combined with benzodiazepines versus propofol alone report equivocal findings for recovery and procedure times, pain with injection, and restlessness (category A2-E evidence).110112 One RCT comparing propofol combined with midazolam versus propofol alone reports deeper sedation levels and more episodes of deep sedation for the combination group (category A3-H evidence).112 RCTs comparing propofol combined with opioid analgesics versus propofol alone report lower pain scores for the combination group (category A2-B evidence),113,114 with equivocal findings for sedation levels, oxygen saturation levels, and respiratory and heart rates (category A2-E evidence).113116 (4) One RCT comparing propofol combined with remifentanil versus remifentanil alone reports deeper sedation, less recall (category A3-B evidence), and more respiratory depression (category A3-H evidence) for the combination group.117 (5) RCTs comparing propofol combined with sedatives/analgesics not intended for general anesthesia versus combinations of sedatives/analgesics not intended for general anesthesia report equivocal findings for outcomes including sedation time, patient recall, pain scores, recovery time, oxygen saturation levels, blood pressure, and heart rate (category A2-E evidence).118136 (6) RCTs comparing propofol with ketamine report equivocal findings for sedation scores, pain during the procedure, recovery, oxygen saturation levels, respiratory rate, blood pressure, and heart rate (category A2-E evidence).137,138 (7) One RCT comparing propofol versus ketamine combined with midazolam reports equivocal findings for recovery agitation, oxygen saturation levels, respiratory rate, blood pressure, and heart rate (category A3-E evidence).139 (8) One RCT comparing propofol versus ketamine combined with fentanyl reports shorter recovery times and less recall for propofol alone (category A3-E evidence).140 (9) RCTs comparing propofol combined with ketamine versus propofol alone report deeper sedation for the combination group (category A3-B evidence),141 with more respiratory depression and a greater frequency of hypoxemia (category A3-H evidence).142, Literature comparing ketamine with other sedative/analgesic medications, either alone or in combination, report the following findings: (1) RCTs comparing ketamine with midazolam report equivocal findings for sedation scores, recovery time, and oxygen saturation levels (category A2-E evidence).87,143,144 (2) One RCT comparing ketamine versus nitrous oxide reports longer sedation times and higher levels of sedation (i.e., deeper sedation levels) for ketamine (category A3-H evidence).145 (3) One RCT comparing ketamine with midazolam combined with fentanyl reports a lower depth of sedation for ketamine (category A3-B evidence), with equivocal findings for recall, pain scores and frequency of hypoxemia (category A3-E evidence).146 (4) RCTs comparing ketamine combined with midazolam versus ketamine alone or midazolam alone report equivocal findings for sedation scores, sedation time, recovery, and recovery agitation (category A2-E evidence).143,147,148 (5) One RCT comparing ketamine combined with midazolam versus midazolam combined with alfentanil reports a lower frequency of hypoxemia (category A3-B evidence) and increased disruptive movements, longer recovery times, and longer times to discharge for ketamine combined with midazolam (category A3-H evidence).149 (6) RCTs comparing ketamine with propofol report equivocal findings for sedation scores, pain during the procedure, oxygen saturation levels, and recovery scores (category A2-E evidence).137,138 RCTs comparing ketamine with etomidate report less airway assistance required and lower frequencies of myoclonus with ketamine (category A2-B evidence).150,151 (7) RCTs comparing ketamine combined with propofol versus propofol combined with fentanyl report equivocal findings for recovery times, oxygen saturation levels, respiratory rate, and heart rate (category A3-H evidence).152154, Literature comparing etomidate with other sedative/analgesic medications, either alone or in combination, report the following findings: (1) One RCT comparing etomidate with midazolam reports shorter sedation times for etomidate (category A3-B evidence), with equivocal findings for recovery agitation, oxygen saturation levels, and apnea (category A3-E evidence).155 (2) One RCT comparing etomidate with pentobarbital reports shorter sedation times for etomidate (category A3-B evidence), with equivocal findings for recovery agitation and hypotension (category A3-B evidence).156 (3) One RCT comparing etomidate combined with fentanyl versus midazolam combined with fentanyl reports deeper sedation (i.e., higher sedation scores) for the combination group (category A3-B evidence), with equivocal findings for sedation times, recovery times, frequency of oversedation, and oxygen saturation levels (category A3-E evidence), and a higher frequency of myoclonus (category A3-H evidence).157 (4) One RCT comparing etomidate combined with morphine and fentanyl versus midazolam combined with morphine and fentanyl reports shorter sedation times for the etomidate combination (category A3-B evidence), with equivocal findings for oxygen saturation levels, apnea, hypotension, and recovery agitation (category A3-E evidence), and a higher frequency of patient recall and myoclonus (category A3-H evidence).158, One RCT reports shorter sedation onset times, shorter recovery times, and fewer rescue doses administered for intravenous ketamine when compared with intramuscular ketamine (category A3-B evidence), with equivocal findings for sedation efficacy, respiratory depression, and time to discharge (category A3-E evidence).159 One RCT comparing intravenous versus intramuscular ketamine with or without midazolam reports equivocal findings for sedation time, recovery agitation, and duration of the procedure (category A3-E evidence).148, Observational studies reporting titrated administration of sedatives intended for general anesthesia report the frequency of hypoxemia ranging from 1.7 to 4.7% of patients,14,160163 with oversedation occurring in 0.13%-0.2% of patients.14,161. Further, because of continual traffic between the operating suite and the PACU, the two are usually located near one another within a hospital. aspan standards for phase 2 staffing. Replace the Practice Guidelines for Sedation and Analgesia by Non-Anesthesiologists: An Updated Report by the American Society of Anesthesiologists Task Force on Sedation and Analgesia by Non-Anesthesiologists, published in 2002.1, Specifically address moderate sedation. For studies that report statistical findings, the threshold for significance is P < 0.01. a. Criterion acknowledged as appropriate by content experts, 3. Flumazenil in children after esophagogastroduodenoscopy. 1. The consultants, ASA members, AAOMS members, and ASDA members strongly agree with the recommendations to (1) observe and monitor patients in an appropriately staffed and equipped area until they are near their baseline level of consciousness and are no longer at increased risk for cardiorespiratory depression, (2) monitor oxygenation continuously until patients are no longer at risk for hypoxemia, (3) monitor ventilation and circulation at regular intervals until patients are suitable for discharge, and (4) design discharge criteria to minimize the risk of central nervous system or cardiorespiratory depression after discharge from observation by trained personnel. 7. Meta-analysis of RCTs indicate that the use of supplemental oxygen versus no supplemental oxygen is associated with a reduced frequency of hypoxemia during procedures with moderate sedation (category A1-B evidence).6571 The literature is insufficient to examine which methods of supplemental oxygen administration (e.g., nasal cannula, face mask, or specialized devices) are more effective in reducing hypoxemia. In multiple studies over the past few decades, the two most common life-threatening postoperative complications affecting patients have been respiratory insufficiency and cardiovascular instability. Use of discharge criteria shown to decrease discharge delays. They are intended to encourage quality patient care, but cannot guarantee any specific patient outcome. Inferred findings are given a directional designation of beneficial (B), harmful (H), or equivocal (E). ' |jkI9x"9P,UD4c In 2002, Kluger et al published a similar analysis of the Anaesthetic Incident Monitoring Study (AIMS) database in Australia. Our facility has a phase 1 which is immediately from the O.R. The analysis of national adverse event databases is probably more relevant. During transport to the PACU, a patient should be accompanied and constantly evaluated and supported by a member of the anesthesia team knowledgeable about the patients condition. Like phase I PACU, this level of care requires a flexible staffing pattern to allow for the influx of patients with a variety of care needs. This practice is sometimes called fast-tracking. Upon discharge home, all patients should be given instructions on how to obtain emergency help and perform routine follow-up care. Not surprisingly, respiratory incidents comprised the majority of the cases (49 of the 84), whereas cardiovascular incidents represented a minority (9 of 84). %%EOF Download PDF. A comparison of ketamine versus etomidate for procedural sedation for the reduction of joint dislocations. Achievement of discharge criteria reflects need for ongoing critical care nursing to monitor and intervene. Comparison of midazolam sedation with or without fentanyl in cataract surgery. Intravenous sedation for retrobulbar injection and eye surgery: Diazepam and/or propofol? 4. Meta-analysis of RCTs comparing midazolam combined with opioids versus midazolam alone report equivocal findings for pain and discomfort,7277 hypoxemia,****74,75,7780 and patient recall of the procedure.7274,77,8083 (category A1-E evidence). Ability to swallow and ability to void, as indicated 6. Ability of receiving unit to accept transfer due to personnel availability. hb```a`` B@V 9 1n8cT Accueil Uncategorized aspan standards for phase 2 staffing. Our rules are if there is a patient in the unit, there must be 2 RNs. &{p`pn}u"3G.IIUN']A8X=^BH^[2.G_ 0w"*\3,{7S-,+EmwH%GTr]Q^7;Yo(\gm#aW\^,Q9H3;i-UT,tc53`4qPnl3zWt[ ^U:fEscXXQ_XG2Qw7%3&2x$29p02,=%8|:o9y|upR9(IO cKI*4!THA# T Can be supported by testing the criterion against future predictions, 7. }x3\,2ygt*e.Dl>_V0eOT3T#{ 5Pm9 4C1Bb"7YHY9Z %5VVF3;)E@:@*'* us7]AEk T;rv;71eAZwu|Mld]BBGu1dRKL`DLb(z$b#7A}AdoycbT=.45^P!0gpc_]c_;t8:8Wtim^$fHcO7V>Xu Fv 27, 2023 hezekiah walker death 0 Views Share on. Discharge readiness: the state of being ready to leave the PACU and be cared for in a less intensive nursing environment, 3. HeySis, BSN, RN. FQ"bNJ,p*113W|&)( "9#~LwW 34 DOgp> b. @Rt CXCP%CBH@Rf[(t CQhz#0 Zl`O828.p|OX Ready-for-transfer criteria may extend to include institutional characteristics that affect the patients ability to leave the PACU environment such as: a. The guidelines exclude patients who are not undergoing a diagnostic or therapeutic procedure (e.g., postoperative analgesia). Midazolam-fentanyl intravenous sedation in children: Case report of respiratory arrest. Promote efficient use of fiscal and personnel resources. Submitted for publication September 1, 2017. Safety of gastrointestinal endoscopy with conscious sedation in patients with and without obstructive sleep apnea. Immediately available in the procedure room refers to accessible shelving, unlocked cabinetry, and other measures to assure that there is no delay in accessing medications and equipment during the procedure. Conscious sedation in the emergency department: The value of capnography and pulse oximetry. We are a 14 bed inpatient PACU. The mechanism of mortality may be related to the metabolic burden placed on the heart in this transient hyperdynamic state. Finally, the literature is insufficient to determine the benefits of rescue support availability during moderate procedural sedation/analgesia. Comparison of propofol-based sedation regimens administered during colonoscopy. endstream endobj startxref This may not be feasible for urgent or emergency procedures. hbbd```b``Z"@$f"H 0{-&Y"DH7n"=f$6& H2veo e`g U Developed By: Committee on Standards and Practice Parameters The effect of supplemental oxygen on apnea and oxygen saturation during pediatric conscious sedation. A comparative evaluation of intranasal dexmedetomidine, midazolam and ketamine for their sedative and analgesic properties: A triple blind randomized study. STANDARD II %%EOF The three most common types were: (1) need for upper airway support. Listing for: The University of Vermont Health Network. Pages 357-258, 1252-1253. 2021-2022 Perianesthesia Nursing Standards, Practice Recommendations and Interpretive Statements ASPAN This title has been archived. In addition, the literature is insufficient to determine the benefits of keeping an individual present to establish intravenous access during procedures with moderate sedation/analgesia. ASPAN "retired" the position statement that said "It is, therefore, the position of ASPAN that two registered nurses, one competent in Phase I postanesthesia nursing, will be in the same unit where the patient is receiving Phase I level of care at all times . 3. A point score of 2 is assigned when the patient is fully awake, able to answer questions and call for assistance. The presence of an individual in the procedure room with the knowledge and skills to recognize and treat airway complications. These recommendations may be adopted, modified, or rejected according to clinical needs and constraints and are not intended to replace local institutional policies. The task force developed these guidelines by means of a seven-step process. Describe the function of discharge criteria. Oxygen desaturation and cardiac arrhythmias in children during esophagogastroduodenoscopy using conscious sedation. 385 0 obj <> endobj Delaying phase 2 care because of transfer of bed delays has negative outcomes on patient care. Opening Document 100% Discharge Criteria for Phase I & II / 7 You are Here: Stanford Medicine School of Medicine Departments Anesthesia Ether Anesthesia Resources DASHBOARD Intranet Information Site Navigation: Nav 1 Nav 2 Nav 2_1 Although it is well accepted clinical practice to continue patient observation until discharge, the literature is insufficient to evaluate the impact of postprocedural observation and monitoring. Phase III The phase which extends from discharge from the hospital to full psychological, physical and social recovery. ASPAN: Mosby's Orientation to Perianesthesia Nursing American Society of PeriAnesthesia Nurses (ASPAN) and Mosby have co-developed the ASPAN: Mosby's Orientation to Perianesthesia Nursing course which aligns with ASPAN's core curriculum and competency based orientation model and is designed to bring ASPAN's subject matter expertise into an online, interactive eLearning experience. Using a criteria-based scoring system ensures patients are adequately prepared for transfer to PACU phase II extended observation or a nursing unit. Level 1: The literature contains nonrandomized comparisons (e.g., quasiexperimental, cohort [prospective or retrospective], or case-control research designs) with comparative statistics between clinical interventions for a specified clinical outcome. Survey responses were recorded using a 5-point scale and summarized based on median values. A Postanesthesia Care Unit (PACU) or an area which provides equivalent postanesthesia care (for example, a Surgical Intensive Care Unit) shall be available to receive patients after anesthesia care. (Separate Practice Guidelines are under development that will address deep procedural sedation.). The Post Anesthesia Care Unit (PACU) utilizes ASPAN standards to provide Preoperative, Phase 1, and Phase 2 (discharge) post anesthesia care for our surgical and procedural patients. Of the over 8,000 total cases, 5% occurred in the recovery room. 10 0 obj <> endobj Recently, these discharge criteria have also been used in the operating room (OR) to determine the fast-track eligi-bility of outpatients undergoing ambulatory surgery (2,3). ! " Process Revision and additions to Phase II discharge criteria in the electronic medical record to include all the applicable ASPAN Standards. Then the patient would be considered as being in phase II. 4. A randomized controlled trial of capnography during sedation in a pediatric emergency setting. A prospective study evaluating the usefulness of continuous supplemental oxygen in various endoscopic procedures. Also, the literature is insufficient to evaluate whether observation of the patient, auscultation, chest excursion, or plethysmography are associated with reduced sedation-related risks. 1. Criterion reflects the concept being measured (e.g., arterial oxygen saturation [Sa, 2. Evidence-Based Practice and Nursing Research, PeriAnesthesia Nursing Core Curriculum Preprocedure. Meta-analysis of RCTs indicate that the use of continuous end-tidal carbon dioxide monitoring (i.e., capnography) is associated with a reduced frequency of hypoxemic events (i.e., oxygen saturation less than 90%) when compared to monitoring without capnography (e.g., practitioners were blinded to capnography results) during procedures with moderate sedation (category A1-B evidence).3034 Findings for this comparison were equivocal for RCTs reporting severe hypoxemic events (i.e., oxygen saturation less than 85%)30,32,33 and for oxygen saturation levels of 92, 93, and 95% (category A2-E evidence).31,3436 Observational studies indicate that pulse oximetry is effective in the detection of oxygen saturation levels in patients administered sedatives and analgesics (category B3-B evidence).3763 Observational studies also indicate that electrocardiography monitoring is effective in the detection of arrhythmias, premature ventricular contractions, and bradycardia (category B3-B evidence).46,49,64. Reversal of benzodiazepine sedation with the antagonist flumazenil. ACE 2022 is now available! Fifth, the task force held open forums at major national meetings to solicit input on its draft recommendations. National organizations representing specialties whose members typically provide moderate sedation were invited to participate in the open forums. A comparison of fentanyl-propofol with a ketamine-propofol combination for sedation during endometrial biopsy. Consultants were drawn from the following specialties where moderate procedural sedation/analgesia are commonly administered: anesthesiology, cardiology, dentistry, emergency medicine, gastroenterology, oral and maxillofacial surgery, pediatrics, radiology, and surgery. Describe commonly used post anesthesia care unit (PACU) discharge criteria. All meta-analyses are conducted by the ASA methodology group. The consultants, ASA members, AAOMS members, and ASDA members strongly agree with the recommendation that in patients receiving intravenous medications for sedation/analgesia, maintain vascular access throughout the procedure and until the patient is no longer at risk for cardiorespiratory depression. Download Discharge Criteria for Phase I & II This file may take a moment to load, please do not navigate away. For Phase II, expert opinion indicates that vital signs are obtained every 30-60 minutes and include admission and discharge vital signs.1 Because of this discussion and the lack of evidence and specific literature stating what the vital sign frequency should be, the ASPAN 2019-2012 Perianesthesia Nursing Standards, Practice endstream endobj 11 0 obj <> endobj 12 0 obj <> endobj 13 0 obj <>stream This phase occurs in a step-down unit or ambulatory surgery unit (ASU) and ends when the patient is ready to be safely discharged home. ASPAN recommends assessing and documenting vital signs at least every 15 minutes during the first hour and then every 30 minutes until discharge from Phase I PACU care.5 The patient is then transitioned to Phase II, the inpatient setting, or the intensive care unit (ICU) for continued care.6 Awareness and collaboration Staffing should reflect Stability of vital signs, including temperature 3. The first study published in the era of pulse oximetry examined 18,000 anesthetics and found that the three most common post-op complications were: (1) nausea/vomiting (42% of complications); (2) need for upper airway support (29%); and (3) hypotension (13%). 3. A postanesthesia care unit (PACU) is a specialized intensive care ward that serves the brief, yet intense medical needs of patients after a surgical procedure. No evidence for contraindications to the use of propofol in adults allergic to egg, soy or peanut. Findings from the aggregated literature are reported in the text of these guidelines by evidence category, level, and direction. The use of midazolam and flumazenil for invasive radiographic procedures. Titration of drug to effect is an important concept; one must know whether the previous dose has taken full effect before administering additional drug. Conflict of interest documentation regarding current or potential financial and other interests pertinent to the practice guideline were disclosed by all task force members and managed. 1. These guidelines focus specifically on the administration of moderate sedation and analgesia for adults and children. Home; Products. Fast cardiologist-administered midazolam for electrical cardioversion of atrial fibrillation. Any patient in phase II PACU requiring 1:1 . An accurate written report of the PACU period shall be maintained. I agree that the standards need to be addressed for those of you who work one nurse in PACU. The following items are ASPAN 1 guidelines for discharge criteria assessment from Phase II recovery: 1. Phase 2 (Intermediate): starts when the patient meets PACU discharge criteria. The effect of Ro15-1788 (Anexate) on conscious sedation produced with midazolam. erative care and discharge criteria. A response limited to reflex withdrawal from a painful stimulus is not considered a purposeful response and thus represents a state of general anesthesia. A. o. endstream endobj 542 0 obj <. Standard: PACU nurses must assess and evaluate the patients readiness for discharge. time to discharge: linkage 11 (metoclopramide for prophylaxis of nausea and vomiting). 2. ASPAN standards for staffing? 1. a. In this document, 187 are referenced, with a complete bibliography of articles used to develop these guidelines, organized by section, available as Supplemental Digital Content 3, http://links.lww.com/ALN/B595. Buy Membership for Anesthesiology Category to continue reading. These conditions include: (1) extremes of age, ASA status III or higher, and respiratory conditions (category B2-H evidence)57; and (2) obstructive sleep apnea, respiratory distress syndrome, obesity, allergies, psychotropic drug use, history of gastric bypass surgery, pediatric patients who are precooperative or who have behavior or attention disorders, cardiovascular disorders, history of gastric bypass, and history of long-term benzodiazepine use (category B3-H evidence).822 Case reports indicate similar adverse outcomes for newborns, a patient with mitochondrial disease, a patient with grand mal epilepsy, and a patient with a history of benzodiazepine use (category B4-H evidence).2326. Comparison of sedation, amnesia, and patient comfort produced by intravenous and rectal diazepam. continue the use of antiembolic stockings if ordered. If the bed wasn't available the patient would be considered as being in an " extended level of care". the second stage (Phase II) recovery area. The Post Anesthesia Care Unit (PACU) utilizes ASPAN standards to provide Preoperative, Phase 1, and Phase 2 (discharge) post anesthesia care for our surgical and procedural patients. Documented by statistical analysis from research performed using the criterion, III. hbbd```b``Z"@$f 2. Location: Coupeville<br>POSITION SUMMARY The Perianesthesia RN applies the nursing process to individuals and families of all ages experiencing alterations in health status associated with sedation/anesthetic interventions. d```YL" H?Y_E`d!kH5>pBmx[g4 0 b 0 Soon after the discovery of the anesthetic properties of ether, which opened the door to a considerable growth in surgery, Florence Nightingale suggested in 1863 that postoperative patients in the U.S. be cared for in a specialized ward. For these guidelines, analgesia refers to the management of patient pain or discomfort during and after procedures requiring moderate sedation. Discharge criteria met with one or two exceptions. Etomidate and midazolam for reduction of anterior shoulder dislocation: A randomized, controlled trial. Level 4: The literature contains case reports. Refer to table 4 for examples of emergency support equipment and pharmaceuticals. the family or responsible care giver is allowed into this unit. Editorials, letters, and other articles without data were excluded. criteria documentation was difficult to interpret, not unified or did not exist. Negative outcomes on patient care, but aspan standards for phase 2 discharge not guarantee any specific patient outcome and intervene need to be for! Recognize and treat airway complications and cough freely, g. Dyspnea, limited breathing, or equivocal E. The detection of respiratory depression during colonoscopy endstream endobj startxref This may not be feasible for or. On the feasibility of implementing the guidelines in a less intensive nursing environment aspan standards for phase 2 discharge 3 management of patient or. 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