Chapter 12 - Outcomes, controversies, and future trends

Summary

The incidence of sedation-related complications for procedures is unknown, as mandatory reporting of outcomes is lacking. However, two sources of information are available that can shed light on the risks of sedation encountered in non-operating-room locations. The American Society of Anesthesiologists (ASA) changed the standards for monitoring of ventilation during moderate or deep sedation to require capnography to measure exhaled carbon dioxide unless precluded or invalidated by the nature of the patient, procedure, or equipment. Sedation-induced respiratory depression may cause brain damage and/or death. Brain function monitoring may have a beneficial role for procedural sedation in the future, but requires more investigation. The major controversies in procedural sedation are the choice of sedative agents and the administration of propofol by non-anesthesia providers. Future drugs include potential use of fospropofol and dexmedetomidine for sedation, patient-controlled sedation and analgesia (PCSA), and computer-assisted personalized sedation (CAPS).