Fatal endotracheal haemorrhage in a patient undergoing repair of a large ascending aortic aneurysm

Abstract

The still ever increasing demand for sedation and/or analgesia for diagnostic and therapeutic procedures puts high pressure on anaesthesia care providers all over Europe. Since the capacity to provide that service by anaesthetists is limited in most European countries, guidelines for non-anaesthetist doctors who want to sedate patients on a high-quality level and especially in a safe way are mandatory. This paper, produced by a working party of the European Board of Anaesthesiology of the European Union of Medical Specialists (EUMS/UEMS), gives direction to those practitioners who feel responsibilities in this area of medicine. Close cooperation with anaesthesiologists seems mandatory to achieve and sustain a high-quality standard for our patients undergoing medical or surgical procedures under sedation.

Bispectral Index Monitoring Reduces the Dosage of Propofol and Adverse Events in Sedation for Endobronchial Ultrasound

“…Mild-to-moderate sedation with benzodiazepines and opioids [18,19] is the type of sedation commonly used by pulmonologists, whereas moderate-to-deep sedation with propofol, alone or in association with opioids [11,20,21], requires the presence of personnel trained to use these drugs, according to current guidelines [22,23,24,25]. Anesthesia protocols vary between hospitals and countries, and no protocol is applied uniformly.…”

Bispectral Index Monitoring during Anesthesiologist-Directed Propofol and Remifentanil Sedation for Endoscopic Submucosal Dissection: A Prospective Randomized Controlled Trial

“…Additionally, continuous propofol infusion with opioids for moderate-to-deep sedation, lengthy procedure times >2 hr, the male gender, and age >75 years have been reported to be independent risk factors for pneumonia after ESD 22. According to the guidelines for sedation and/or analgesia by non-anesthesiologists, the accurate titration of drugs and close communication between the patient and the physician are recommended to achieve a high quality of mild-to-moderate sedation for diagnostic or therapeutic procedures 23,24. However, in cases requiring more than moderate depths of sedation for ESD, monitoring mainly relies on the direct observation of the patients' behaviors or responses to voice and physical stimuli through the MOAA/S.…”

Endoscopic Sedation: From Training to Performance

“…They should be trained in life support techniques such as BLS or ACLS, and NAAP training courses teach BLS techniques to all participants and ACLS to healthcare providers who practice in locations where an ACLS provider is not immediately available 1,3,13,16,17. Additionally, BLS techniques may be essential for an adequate response to adverse events during endoscopy sedation using other drugs besides propofol.…”

“…Additionally, BLS techniques may be essential for an adequate response to adverse events during endoscopy sedation using other drugs besides propofol. The European Board of Anesthesiology recommends that NAAP-trained endoscopists who perform patient sedation should be trained in ACLS techniques including endotracheal intubation, and that training of nurses should be similar to the training of medical staff, but focused on BLS 16,18,19,20. However, ACLS training is usually not recommended as a routine course.…”

“…However, ACLS training is usually not recommended as a routine course. Practical endotracheal intubation skills are difficult, and while training for extremely low-frequency of adverse events is not recommended, regular participation in education is needed for NAAP 3,13,16,17,21,22. At minimum, a BLS course is warranted in a basic endoscopic sedation curriculum, and more advanced education and training in ACLS may be necessary for prolonged and complex procedures such as endoscopic retrograde cholangiopancreatography (ERCP), endoscopic ultrasound (EUS)-interventional therapy, double-balloon enteroscopy, or endoscopic submucosal dissection (ESD) requiring deep sedation.…”