- 2019;22;201-207ASIPP Guidelines for Sedation and Fasting Status of Patients Undergoing Interventional Pain Management Procedures
Alan D. Kaye, MD, PhD, Mark R. Jones, MD, Omar Viswanath, MD, Kenneth D. Candido, MD, Mark V. Boswell, MD, PhD, Amol Soin, MD, Mahendra Sanapati, MD, Michael E. Harned, MD, Thomas T. Simopoulos, MD, Sudhir Diwan, MD, Sheri L. Albers, DO, Sukdeb Datta, MD, Frank JE Falco, MD, and Laxmaiah Manchikanti, MD.
Many of the patients undergoing interventional procedures have daily regimens of medications including analgesics, muscle relaxants, and other drugs that can have significant additive/synergistic effects during the perioperative period. Further, many patients also present with comorbid states, including obesity, cardiovascular, and pulmonary disease. Consequently, in the perioperative period, a significant number of patients have suffered permanent neurologic injury, hypoxic brain injury, and even death as a result of over sedation, hypoventilation, and spinal cord injury. In addition, physicians are concerned about aspiration, subsequent complications, and as a result, they ask patients to fast for several hours prior to the procedures.
Based on extensive literature and consensus, a minimum fasting period is established as 2 hours before a procedure for clear liquids and 4 hours before procedure for light meals, rather than having all patients fast for 8 hours or even fasting beginning at midnight the night before the procedure. Gastrointestinal stimulants, gastric acid secretion blockers, and antacids may be used, even though not routinely recommended.
Due to the nature of chronic pain and anxiety, many patients undergoing interventional techniques may require mild to moderate sedation. Deep sedation and/or general anesthesia for most interventional procedures is considered as unsafe, since the patient cannot communicate acute changes in symptoms, thus, resulting in morbidity and mortality, as well as creating compliance issues. We are adapting the published standards of the American Society of Anesthesiologists for monitoring patients under sedation, regardless of the location of the procedure, either office-based, in a surgery center, or a hospital outpatient department. These standards include monitoring of blood pressure, cardiac rhythm, temperature, pulse oximetry, and continuous quantitative end tidal CO2 monitoring. Sedation must be provided either by qualified anesthesia or non-anesthesia providers, with appropriate understanding of the medications, drug interactions, and resuscitative protocols.
KEY WORDS: Guidelines, sedation, fasting status, monitoring, neurological complications