Recovery and Discharge
The purpose of postsedation monitoring is to ensure that the patient has returned to an acceptable level of functioning as described below before being discharged. The time needed for recovery prior to discharge will vary depending on the type and length of the procedure that was performed; the kinds of sedation/analgesic agents used and the quantity administered; the presence of procedural complications; and the age and physiologic condition of the patient going into the procedure. Consciousness level, hemodynamic parameters, oxygenation, and pain level should be measured at regular intervals until all values have returned to baseline. Since the effects of naloxone and flumazenil are of shorter duration than those of the benzodiazepines and opioids they reverse, a more extended monitoring period (up to 2 hours) may be required if these reversal agents have been used.
Postsedation Monitoring
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Steps following the procedure include: - Monitoring in a designated recovery area until consciousness has returned to baseline and vital signs are within acceptable limits. A standardized discharge scoring system such as the Aldrete score should be employed to determine the patient’s recovery.
- Measurement of heart rate, blood pressure, pulse oximetry, and respiratory rate at least every 5 minutes during recovery.
Also see ASA Standards for Postanesthesia Care - Availability of resuscitation equipment and individual capable of managing complications throughout recovery.
- Patient observation for up to 2 hours after administration of reversal agents to ensure that patient does not become resedated after agents wear off.
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A patient can be deemed suitable for discharge when the physiologic criteria are met and he or she is able to dress and walk independently. The patient does not need to be evaluated for tolerance of fluids or solids before being discharged home. Upon discharge, all patients need to receive verbal and written instructions outlining diet, activity, medication, and follow-up instructions. A 24-hour contact number should be provided to the patient in the event of complications. Upon discharge, the patient must be released only into the care of a responsible adult who can accompany him home.
SourcesCohen, LB et al. AGA Institute Review of Endoscopic Sedation, Gastronenterology 2007;133:675-701.
Van Dam J, Wong RCK. Handbook of Gastrointestinal Endoscopy, Georgetown,Texas: Landes Bioscience; 2004:3.
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Last Updated December 1, 2008