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October 24, 2005
9:00:00 AM - 10:30:00 AM
Room C306
A Survey of Deep Sedation Practices by Non-Anesthesiologists at Teaching Hospitals: Time To Take Action?
Roy G. Soto, M.D., Peter S.A. Glass, M.B., Ch.B.
Anesthesiology, Stony Brook University, Stony Brook, New York, United States
Background The Continuum of Sedation is defined by the ASA as a level at which consciousness is lost (but not response to noxious stimulus) and where airway intervention may be required and ventilation may be inadequate. JCAHO standards require accredited healthcare facilities to have policies in place to guide safe administration of sedation, and the responsibility for oversight frequently falls to anesthesia departments. We sought to determine the role of nonanesthesia providers in administering deep sedation in academic medical centers.

The following 8 question survey was sent to anesthesia program directors via the SAAC/AAPD listserver. Comments were also solicited.

1) Does your institution credential non-anesthesiologists for deep


2) If yes to question 1 do you require advanced cardiac life support


3) If yes to question 1 do you require any formal training in managing

cases of deep sedation?

4) If yes to question 1 do you require any formal training in management

of cases under general anesthesia.

5) If yes for either 3 or 4 do you require that the individual is also

evaluated for competency in managing deep sedation/general anesthesia?

6) Do you require any other form of training for non anesthesiologist to

obtain credentials for DEEP sedation.

7) If yes what other training?

8) If you do have non anesthesiologists credentialed for deep sedation

are they allowed to do the procedure and supervise the deep sedation by a

non-MD simultaneously as is practiced with conscious sedation.

Responses were obtained from 37 institutions. 59% of respondents indicated that their institution allowed nonanesthesia providers to perform deep sedation. In the majority of cases the providers were pediatric/adult intensivists, oral surgeons, or emergency physicians. Only one program indicated that privileges were granted to a single cardiologist, and none allowed gastroenterologists to provide deep sedation. Training requirements varied widely, and included age-appropriate life support, proof of experience from residency training, training with anesthesiologists in the OR, supervision of a number of sedations by an anesthesiologist, written testing, and ongoing CME credit.

Deep sedation is a term that denotes a level of consciousness at which hemodynamic homeostasis and airway protection may be compromised and thus requires certain skils for its management. Furthermore, JCAHO guidelines require that anyone providing sedation be able to rescue a patient from the next deeper level of sedation, which in the case of deep sedation would be general anesthesia. Our results indicate that anesthesia departments vary greatly in their acceptance of non-anesthesiologists providing deep sedation. In addition, where non-anesthesiologists are accredited, the rigor to obtain such credentialling is extremely variable. We propose that deep sedation is the same as any procedure that requires both a knowledge base and demonstration of adequate skills. It would appear that a joint effort by the anesthesia community is needed to create a unified policy for the credentialling of deep sedation by non-anesthesiologists.

Anesthesiology 2005; 103: A614