الفهرس 
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Abstract
Summary
The number of noninvasive and minimally invasive procedures
performed outside of the operating room has grown dramatically over the last
several decades.
Recently, more medically complex patients have been undergoing more
procedures outside the operating room, due to technological advances in
medicine, the increased proficiency of proceduralists and a raised awareness of
healthcare costs. So, conscious sedation is the preferred practice for these
procedures.
Conscious sedation is defined as a medically controlled state of
depressed consciousness that allows protective reflexes to be maintained,
retains the patient to maintain a patent airway independently and continuously
and permits appropriate response of the patient to physical stimulation and
verbal commands.
A wide variety of drugs are used to provide sedation and analgesia. The
ideal drug should have a rapid onset of action with a predictable dose-effect
relationship with respect to its sedative-hypnotic actions. Excitatory effects
should be minimal as should be its respiratory and cardiovascular depressant
effects.
Drugs commonly used are Benzodiazepines, propofol, ketamine, short
acting barbiturates, chloral hydrate, short acting opioids, local anaesthetics.
Adjuvant agents as anticholinergic, antihistaminics, and anti-emetics.
Procedures performed outside operating room have problems in
common as distant location, long transport to PACU, Awkward position of
patients, remote monitoring and lack of help.
sedation is provided in many suites such as gastrointestinal
endoscopy, cardiac catheterization, cardioversion, radiology suites, dental
suites and emergency department.
Monitoring of patients receiving conscious sedation include respiratory
monitoring by pulse oximetry and capnography. Cardiovascular system is
monitored by arterial pulse arterial-blood pressure and ECG. Temperature
monitoring to prevent hypothermia and shivering which may be uncomfortable
to the patient, this is achieved by a thermometer applied in the axilla as rectal
or nasopharyngeal probes are impractical. C.N.S. monitoring by careful
evaluation of the efficacy of conscious sedation in achieving the desired degree
of analgesia, sedation and anxiolysis. Recovery room monitoring to assess the
residual effects of drugs administered and to determine when the patient is fit
for discharge.
Sedation and analgesia for pediatrics require psychological preparation
of the child, parents should be informed; of the procedure, medications,
complications and should also given a checklist to use in preparing the child
for the procedure.
The dosage of sedative and analgesic drugs in this group is higher on a
per-kilogram basis. Drugs in common use are: midazolam, chloral hydrate,
pentobarbital or ketatmine.
Lastly, our goal is the safe use of conscious sedation and careful
attention to prevention of complication.