Challenges in procedural sedation and analgesia

Introduction. There are several definitions given by various anesthesiology professional organizations that explain the term procedural sedation and analgesia (PSA). The International Committee for the Advancement of PSA has defined procedural sedation as the use of anxiolytics, sedatives, hypnotics, analgesics and/or dissociative drugs to alleviate anxiety, pain and/or movement. These agents are used to facilitate the attainment of amnesia or to reduce the consciousness and/or comfort and safety of the patient during diagnostic or therapeutic procedures. The first guidelines for sedation are based on the mandatory signing of informed consent, monitoring and measuring of vital parameters, implementing a fasting regimen before sedation, possessing the skills to establish and maintain the airway, and resuscitation measures. Since PSA is most often used outside the operating room, this type of anesthesia activity is known as NORA (Non-Operating Room Anesthesia Care). Conclusion. Preprocedural evaluation and preparation, periprocedural management, monitoring and care of postprocedural recovery from PSA is similar to those of general or regional anesthesia. In conclusion, a number of logistical and practical difficulties should be noted, such as the availability of medicines and appropriate staff training, as well as the application of global guidelines on PSA.