Critical care - Sedation assessment: Nursing

Sedation is a pharmacologically induced state of calm relaxation or sleepiness that alleviates the discomfort, anxiety and agitation is often experienced by patients in critical care.

It can be used to ensure patient safety during invasive procedures and to improve synchrony with mechanical ventilation.

Now, the levels of sedation include light sedation, moderate sedation, deep sedation and general anesthesia. Light sedation is a minimal level of sedation that provides relief of anxiety.

The patient's cognitive function and physical coordination is slightly impaired, but they can respond to verbal commands and their ventilatory and cardiovascular functions are not impacted.

Light sedation is used during procedures that can make patients feel anxious like during an MRI. Next is moderate sedation, also known as conscious or procedural sedation.

The patient's level of conscious awareness is reduced so they can respond purposely to verbal commands or to a tactile stimulus like a gentle touch to the arm or hand.

Patients can usually maintain their own airway but sometimes they may require supplemental oxygen. Cardiovascular function is also usually maintained moderate sedation can be used for procedures like certain tube or line insertions or endoscopic procedures.

Then there's deep sedation where the patient's consciousness is depressed to a point where they're not easily aroused, but they can respond to repeated or painful stimuli.

Patients can't adequately maintain their own airway. So support is needed like through intubation and ventilation.

Cardiovascular function is usually maintained. This level of sedation is common in longer or more invasive procedures like a cardiac catheterization.

Lastly, general anesthesia is where the patient is completely unarousable. Patients can't maintain their airway or breathing.

So they require full ventilatory support through intubation and ventilation. This type of sedation is used during complex and invasive surgical procedures like an appendectomy or coronary artery bypass grafting.

Ok. When caring for your patient receiving sedation begin by assessing your patient's airway breathing and circulation or ABC S for any emergent life threating findings activate emergency protocols as needed.

Next. Be sure your patient is on a continuous monitor and assess their level of sedation using a standardized assessment scale such as the Richmond agitation sedation scale or ras or the sedation agitation scale or SAS.

These scales measure your patient's responsiveness and level of agitation which can range from being combative, violent and an immediate danger to themselves or staff to being unresponsive to voice or physical stimulation.

The specific target level on the sedation scale is achieved by titrating the pharmacological agents used to induce sedation.

Patients are then monitored closely to ensure their sedation level remains consistent with their targeted goal to prevent under or over sedation.

Bearing in mind that the goal is to provide the lowest level of sedation needed to keep your patient comfortable. Also, the target level should be reassessed regularly and may change depending on your patient's condition.

Keep in mind that patients can metabolize sedative medications at different rates, meaning the same dose of a medication can affect patients differently.

So the intended target may not always be achieved with standard dosing. Also remember that most sedative medications don't provide analgesia.

So be sure to assess your patient for pain using either a verbal pain scale. If your patient is able to verbalize or a behavioral pain scale, that relies on your patient's behaviors and your observations to determine a pain level.

All right, as a quick recap sedation is a pharmacologically induced state of calm relaxation or sleepiness that alleviates the discomfort, anxiety and agitation that's often experienced by patients in critical care.

It can be used to ensure patients safety during invasive procedures and to improve synchrony with mechanical ventilation.

When caring for your patient receiving sedation, you'll provide an ongoing assessment of their level of sedation and pain.