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Practice Guidelines for Sedation and Analgesia by Non-Anesthesiologists

An Updated Report by the American Society of Anesthesiologists Task Force on Sedation and Analgesia by Non-Anesthesiologists

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ANESTHESIOLOGISTS possess specific expertise in the pharmacology, physiology, and clinical management of patients receiving sedation and analgesia. For this reason, they are frequently called on to participate in the development of institutional policies and procedures for sedation and analgesia for diagnostic and therapeutic procedures. To assist in this process, the American Society of Anesthesiologists (ASA) has developed these “Guidelines for Sedation and Analgesia by Non-Anesthesiologists.”
Practice guidelines are systematically developed recommendations that assist the practitioner and patient in making decisions about health care. These recommendations may be adopted, modified, or rejected according to clinical needs and constraints. Practice guidelines are not intended as standards or absolute requirements. The use of practice guidelines cannot guarantee any specific outcome. Practice guidelines are subject to revision as warranted by the evolution of medical knowledge, technology, and practice. The guidelines provide basic recommendations that are supported by analysis of the current literature and by a synthesis of expert opinion, open forum commentary, and clinical feasibility data.
This revision includes data published since the “Guidelines for Sedation and Analgesia by Non-Anesthesiologists” were adopted by the ASA in 1995; it also includes data and recommendations for a wider range of sedation levels than was previously addressed.
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Definitions

Table 1
Table 1
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“Sedation and analgesia” comprise a continuum of states ranging from minimal sedation (anxiolysis) through general anesthesia. Definitions of levels of sedation–analgesia, as developed and adopted by the ASA, are given in table 1. These Guidelines specifically apply to levels of sedation corresponding to moderate sedation (frequently called conscious sedation) and deep sedation, as defined in table 1.
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Focus

These Guidelines are designed to be applicable to procedures performed in a variety of settings (e.g., hospitals, freestanding clinics, physician, dental, and other offices) by practitioners who are not specialists in anesthesiology. Because minimal sedation (anxiolysis) entails minimal risk, the Guidelines specifically exclude it. Examples of minimal sedation include peripheral nerve blocks, local or topical anesthesia, and either (1) less than 50% nitrous oxide (N2O) in oxygen with no other sedative or analgesic medications by any route, or (2) a single, oral sedative or analgesic medication administered in doses appropriate for the unsupervised treatment of insomnia, anxiety, or pain. The Guidelines also exclude patients who are not undergoing a diagnostic or therapeutic procedure (e.g., postoperative analgesia, sedation for treatment of insomnia). Finally, the Guidelines do not apply to patients receiving general or major conduction anesthesia (e.g., spinal or epidural/caudal block), whose care should be provided, medically directed, or supervised by an anesthesiologist, the operating practitioner, or another licensed physician with specific training in sedation, anesthesia, and rescue techniques appropriate to the type of sedation or anesthesia being provided.
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Purpose

The purpose of these Guidelines is to allow clinicians to provide their patients with the benefits of seda-tion/analgesia while minimizing the associated risks. Sedation/analgesia provides two general types of benefit: (1) sedation/analgesia allows patients to tolerate unpleasant procedures by relieving anxiety, discomfort, or pain; and (2) in children and uncooperative adults, sedation–analgesia may expedite the conduct of procedures that are not particularly uncomfortable but that require that the patient not move. At times, these sedation practices may result in cardiac or respiratory depression, which must be rapidly recognized and appropriately managed to avoid the risk of hypoxic brain damage, car-diac arrest, or death. Conversely, inadequate sedation– analgesia may result in undue patient discomfort or patient injury because of lack of cooperation or adverse physiologic or psychological response to stress.
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Application

These Guidelines are intended to be general in their application and broad in scope. The appropriate choice of agents and techniques for sedation/analgesia is dependent on the experience and preference of the individual practitioner, requirements or constraints imposed by the patient or procedure, and the likelihood of producing a deeper level of sedation than anticipated. Because it is not always possible to predict how a specific patient will respond to sedative and analgesic medications, practitioners intending to produce a given level of sedation should be able to rescue patients whose level of sedation becomes deeper than initially intended. For moderate sedation, this implies the ability to manage a compromised airway or hypoventilation in a patient who responds purposefully after repeated or painful stimulation, whereas for deep sedation, this implies the ability to manage respiratory or cardiovascular instability in a patient who does not respond purposefully to painful or repeated stimulation. Levels of sedation referred to in the recommendations relate to the level of sedation intended by the practitioner. Examples are provided to illustrate airway assessment, preoperative fasting, emergency equipment, and recovery procedures; however, clinicians and their institutions have ultimate responsibility for selecting patients, procedures, medications, and equipment.
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Task Force Members and Consultants

The ASA appointed a Task Force of 10 members to (1) review the published evidence; (2) obtain the opinion of a panel of consultants, including non-anesthesiologist physicians and dentists who routinely administer sedation–analgesia, as well as of anesthesiologists with a special interest in sedation–analgesia (see Appendix I); and (3) build consensus within the community of practitioners likely to be affected by the Guidelines. The Task Force included anesthesiologists in both private and academic practices from various geographic areas of the United States, a gastroenterologist, and methodologists from the ASA Committee on Practice Parameters.
This Practice Guideline is an update and revision of the ASA “Guidelines for Sedation and Analgesia by Non-Anesthesiologists.”1 The Task Force revised and updated the Guidelines by means of a five-step process. First, original published research studies relevant to the revision and update were reviewed and analyzed; only articles relevant to the administration of sedation by non-anesthesiologists were evaluated. Second, the panel of expert consultants was asked to (1) participate in a survey related to the effectiveness and safety of various methods and interventions that might be used during sedation–analgesia, and (2) review and comment on the initial draft report of the Task Force. Third, the Task Force held open forums at two major national meetings to solicit input on its draft recommendations. National organizations representing most of the specialties whose members typically administer sedation–analgesia were invited to send representatives. Fourth, the consultants were surveyed to assess their opinions on the feasibility and financial implications of implementing the revised and updated Guidelines. Finally, all of the available information was used by the Task Force to finalize the Guidelines.
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Availability and Strength of Evidence

Evidence-based Guidelines are developed by a rigorous analytic process. To assist the reader, the Guidelines make use of several descriptive terms that are easier to understand than the technical terms and data that are used in the actual analyses. These descriptive terms are defined below.
The following terms describe the strength of scientific data obtained from the scientific literature:
Supportive: There is sufficient quantitative information from adequately designed studies to describe a statistically significant relationship (P < 0.01) between a clinical intervention and a clinical outcome, using metaanalysis.
Suggestive: There is enough information from case reports and descriptive studies to provide a directional assessment of the relationship between a clinical intervention and a clinical outcome. This type of qualitative information does not permit a statistical assessment of significance.
Equivocal: Qualitative data have not provided a clear direction for clinical outcomes related to a clinical intervention, and (1) there is insufficient quantitative information or (2) aggregated comparative studies have found no quantitatively significant differences among groups or conditions.
The following terms describe the lack of available scientific evidence in the literature:
Inconclusive: Published studies are available, but they cannot be used to assess the relation between a clinical intervention and a clinical outcome because the studies either do not meet predefined criteria for content as defined in the “Focus” of these Guidelines, or do not provide a clear causal interpretation of findings because of research design or analytic concerns.
Insufficient: There are too few published studies to investigate a relationship between a clinical intervention and clinical outcome.
Silent: No studies that address a relationship of interest were found in the available published literature.
The following terms describe survey responses from the consultants for any specified issue. Responses were solicited on a five-point scale, ranging from 1 (strongly disagree) to 5 (strongly agree), with a score of 3 being neutral.
Strongly Agree: median score of 5
Agree: median score of 4
Equivocal: median score of 3
Disagree: median score of 2
Strongly Disagree: median score of 1
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Guidelines

Patient Evaluation
There is insufficient published evidence to evaluate the relationship between sedation–analgesia outcomes and the performance of a preprocedure patient evaluation. There is suggestive evidence that some preexisting medical conditions may be related to adverse outcomes in patients receiving either moderate or deep sedation/analgesia. The consultants strongly agree that appropriate preprocedure evaluation (history, physical examination) increases the likelihood of satisfactory sedation and decreases the likelihood of adverse outcomes for both moderate and deep sedation.
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Recommendations.
Clinicians administering sedation/analgesia should be familiar with sedation-oriented aspects of the patient's medical history and how these might alter the patient's response to sedation/analgesia. These include: (1) abnormalities of the major organ systems; (2) previous adverse experience with sedation/analgesia as well as regional and general anesthesia; (3) drug allergies, current medications, and potential drug interactions; (4) time and nature of last oral intake; and (5) history of tobacco, alcohol, or substance use or abuse. Patients presenting for sedation/analgesia should undergo a focused physical examination, including vital signs, auscultation of the heart and lungs, and evaluation of the airway. (Example I). Preprocedure laboratory testing should be guided by the patient's underlying medical condition and the likelihood that the results will affect the management of sedation/analgesia. These evaluations should be confirmed immediately before sedation is initiated.
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Preprocedure Preparation
The literature is insufficient regarding the benefits of providing the patient (or legal guardian, in the case of a child or impaired adult) with preprocedure information about sedation and analgesia. For moderate sedation the consultants agree, and for deep sedation the consultants strongly agree that appropriate preprocedure counseling of patients regarding risks, benefits, and alternatives to sedation and analgesia increases patient satisfaction.
Table. Example I.Air...
Table. Example I.Air...
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TABLE
Sedatives and analgesics tend to impair airway reflexes in proportion to the degree of sedation–analgesia achieved. This dependence on level of sedation is reflected in the consultants opinion: They agree that preprocedure fasting decreases risks during moderate sedation, while strongly agreeing that it decreases risks during deep sedation. In emergency situations, when preprocedure fasting is not practical, the consultants agree that the target level of sedation should be modified (i.e., less sedation should be administered) for moderate sedation, while strongly agreeing that it should be modified for deep sedation. The literature does not provide sufficient evidence to test the hypothesis that preprocedure fasting results in a decreased incidence of adverse outcomes in patients undergoing either moderate or deep sedation.
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Recommendations.
Patients (or their legal guardians in the case of minors or legally incompetent adults) should be informed of and agree to the administration of sedation/analgesia, including its benefits, risks, and limitations associated with this therapy, as well as possible alternatives. Patients undergoing sedation/analgesia for elective procedures should not drink fluids or eat solid foods for a sufficient period of time to allow for gastric emptying before their procedure, as recommended by the ASA “Guidelines for Preoperative Fasting”2 (Example II). In urgent, emergent, or other situations in which gastric emptying is impaired, the potential for pulmonary aspiration of gastric contents must be considered in determining (1) the target level of sedation, (2) whether the procedure should be delayed,or (3) whether the trachea should be protected by intubation.
Table. Example II.Su...
Table. Example II.Su...
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TABLE
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Monitoring Level of Consciousness.
The response of patients to commands during procedures performed with sedation/analgesia serves as a guide to their level of consciousness. Spoken responses also provide an indication that the patients are breathing. Patients whose only response is reflex withdrawal from painful stimuli are deeply sedated, approaching a state of general anesthesia, and should be treated accordingly. The literature is silent regarding whether monitoring patients’ level of consciousness improves patient outcomes or decreases risks. The consultants strongly agree that monitoring level of consciousness reduces risks for both moderate and deep sedation. The members of the Task Force believe that many of the complications associated with sedation and analgesia can be avoided if adverse drug responses are detected and treated in a timely manner (i.e., before the development of cardiovascular decompensation or cerebral hypoxia). Patients given sedatives or analgesics in unmonitored settings in anticipation of a subsequent procedure may be at increased risk of these complications.
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Pulmonary Ventilation.
It is the opinion of the Task Force that the primary causes of morbidity associated with sedation/analgesia are drug-induced respiratory depression and airway obstruction. For both moderate and deep sedation, the literature is insufficient to evaluate the benefit of monitoring ventilatory function by observation or auscultation. However, the consultants strongly agree that monitoring of ventilatory function by observation or auscultation reduces the risk of adverse outcomes associated with sedation/analgesia. The consultants were equivocal regarding the ability of capnography to decrease risks during moderate sedation, while agreeing that it may decrease risks during deep sedation. In circumstances in which patients are physically separated from the caregiver, the Task Force believes that automated apnea monitoring (by detection of exhaled carbon dioxide or other means) may decrease risks during both moderate and deep sedation, while cautioning practitioners that impedance plethysmography may fail to detect airway obstruction. The Task Force emphasizes that because ventilation and oxygenation are separate though related physiologic processes, monitoring oxygenation by pulse oximetry is not a substitute for monitoring ventilatory function.
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Oxygenation.
Published data suggest that oximetry effectively detects oxygen desaturation and hypoxemia in patients who are administered sedatives/analgesics. The consultants strongly agree that early detection of hypoxemia through the use of oximetry during seda-tion–analgesia decreases the likelihood of adverse outcomes such as cardiac arrest and death. The Task Force agrees that hypoxemia during sedation and analgesia is more likely to be detected by oximetry than by clinical assessment alone.
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Hemodynamics.
Although there are insufficient published data to reach a conclusion, it is the opinion of the Task Force that sedative and analgesic agents may blunt the appropriate autonomic compensation for hypovolemia and procedure-related stresses. On the other hand, if sedation and analgesia are inadequate, patients may develop potentially harmful autonomic stress responses (e.g., hypertension, tachycardia). Early detection of changes in patients’ heart rate and blood pressure may enable practitioners to detect problems and intervene in a timely fashion, reducing the risk of these complications. The consultants strongly agree that regular monitoring of vital signs reduces the likelihood of adverse outcomes during both moderate and deep sedation. For both moderate and deep sedation, a majority of the consultants indicated that vital signs should be monitored at 5-min intervals once a stable level of sedation is established. The consultants strongly agree that continuous electrocardiography reduces risks during deep sedation, while they were equivocal regarding its effect during moderate sedation. However, the Task Force believes that electrocardiographic monitoring of selected patients (e.g., with significant cardiovascular disease or dysrhythmias) may decrease risks during moderate sedation.
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Recommendations.
Monitoring of patient response to verbal commands should be routine during moderate sedation, except in patients who are unable to respond appropriately (e.g., young children, mentally impaired or uncooperative patients), or during procedures where movement could be detrimental. During deep sedation, patient responsiveness to a more profound stimulus should be sought, unless contraindicated, to ensure that the patient has not drifted into a state of general anesthesia. During procedures where a verbal response is not possible (e.g., oral surgery, upper endoscopy), the ability to give a “thumbs up” or other indication of consciousness in response to verbal or tactile (light tap) stimulation suggests that the patient will be able to control his airway and take deep breaths if necessary, corresponding to a state of moderate sedation. Note that a response limited to reflex withdrawal from a painful stimulus is not considered a purposeful response and thus represents a state of general anesthesia.
All patients undergoing sedation/analgesia should be monitored by pulse oximetry with appropriate alarms. If available, the variable pitch “beep,” which gives a continuous audible indication of the oxygen saturation reading, may be helpful. In addition, ventilatory function should be continually monitored by observation or auscultation. Monitoring of exhaled carbon dioxide should be considered for all patients receiving deep sedation and for patients whose ventilation cannot be directly observed during moderate sedation. When possible, blood pressure should be determined before sedation/analgesia is initiated. Once sedation–analgesia is established, blood pressure should be measured at 5-min intervals during the procedure, unless such monitoring interferes with the procedure (e.g., pediatric magnetic resonance imaging, where stimulation from the blood pressure cuff could arouse an appropriately sedated patient). Electrocardiographic monitoring should be used in all patients undergoing deep sedation. It should also be used during moderate sedation in patients with significant cardiovascular disease or those who are undergoing procedures where dysrhythmias are anticipated.
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Recording of Monitored Parameters
The literature is silent regarding the benefits of contemporaneous recording of patients’ level of consciousness, respiratory function, or hemodynamics. Consultant opinion agrees with the use of contemporaneous recording for moderate sedation and strongly agrees with its use for patients undergoing deep sedation. It is the consensus of the Task Force that, unless technically precluded (e.g., uncooperative or combative patient), vital signs and respiratory variables should be recorded before initiating sedation/analgesia, after administration of sedative–analgesic medications, at regular intervals during the procedure, on initiation of recovery, and immediately before discharge. It is the opinion of the Task Force that contemporaneous recording (either automatic or manual) of patient data may disclose trends that could prove critical in determining the development or cause of adverse events. In addition, manual recording ensures that an individual caring for the patient is aware of changes in patient status in a timely fashion.
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Recommendations.
For both moderate and deep sedation, patients’ level of consciousness, ventilatory and oxygenation status, and hemodynamic variables should be assessed and recorded at a frequency that depends on the type and amount of medication administered, the length of the procedure, and the general condition of the patient. At a minimum, this should be: (1) before the beginning of the procedure; (2) after administration of sedative–analgesic agents; (3) at regular intervals during the procedure, (4) during initial recovery; and (5) just before discharge. If recording is performed automatically, device alarms should be set to alert the care team to critical changes in patient status.
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Availability of an Individual Responsible for Patient Monitoring
Although the literature is silent on this issue, the Task Force recognizes that it may not be possible for the individual performing a procedure to be fully cognizant of the patient's condition during sedation/analgesia. For moderate sedation, the consultants agree that the availability of an individual other than the person performing the procedure to monitor the patient's status improves patient comfort and satisfaction and that risks are reduced. For deep sedation, the consultants strongly agree with these contentions. During moderate sedation, the consultants strongly agree that the individual monitoring the patient may assist the practitioner with interruptible ancillary tasks of short duration; during deep sedation, the consultants agree that this individual should have no other responsibilities.
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Recommendation.
A designated individual, other than the practitioner performing the procedure, should be present to monitor the patient throughout procedures performed with sedation/analgesia. During deep sedation, this individual should have no other responsibilities. However, during moderate sedation, this individual may assist with minor, interruptible tasks once the patient's level of sedation–analgesia and vital signs have stabilized, provided that adequate monitoring for the patient's level of sedation is maintained.
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Training of Personnel
Although the literature is silent regarding the effectiveness of training on patient outcomes, the consultants strongly agree that education and training in the pharmacology of agents commonly used during sedation–analgesia improves the likelihood of satisfactory sedation and reduces the risk of adverse outcomes from either moderate or deep sedation. Specific concerns may include: (1) potentiation of sedative-induced respiratory depression by concomitantly administered opioids; (2) inadequate time intervals between doses of sedative or analgesic agents, resulting in a cumulative overdose; and (3) inadequate familiarity with the role of pharmacologic antagonists for sedative and analgesic agents.
Because the primary complications of sedation/analgesia are related to respiratory or cardiovascular depression, it is the consensus of the Task Force that the individual responsible for monitoring the patient should be trained in the recognition of complications associated with sedation/analgesia. Because sedation/analgesia constitutes a continuum, practitioners administering moderate sedation should be able to rescue patients who enter a state of deep sedation, whereas those intending to administer deep sedation should be able to rescue patients who enter a state of general anesthesia. Therefore, the consultants strongly agree that at least one qualified individual trained in basic life support skills (cardiopulmonary resuscitation, bag-valve-mask ventilation) should be present in the procedure room during both moderate and deep sedation. In addition, the consultants strongly agree with the immediate availability (1–5 min away) of an individual with advanced life support skills (e.g., tracheal intubation, defibrillation, use of resuscitation medications) for moderate sedation and in the procedure room itself for deep sedation.
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Recommendations.
Individuals responsible for patients receiving sedation–analgesia should understand the pharmacology of the agents that are administered, as well as the role of pharmacologic antagonists for opioids and benzodiazepines. Individuals monitoring patients receiving sedation/analgesia should be able to recognize the associated complications. At least one individual capable of establishing a patent airway and positive pressure ventilation, as well as a means for summoning additional assistance, should be present whenever sedation–analgesia is administered. It is recommended that an individual with advanced life support skills be immediately available (within 5 min) for moderate sedation and within the procedure room for deep sedation.
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Availability of Emergency Equipment
Although the literature is silent, the consultants strongly agree that the ready availability of appropriately sized emergency equipment reduces risks associated with both moderate and deep sedation. The literature is also silent regarding the need for cardiac defibrillators during sedation/analgesia. During moderate sedation, the consultants agree that a defibrillator should be immediately available for patients with both mild (e.g., hypertension) and severe (e.g., ischemia, congestive failure) cardiovascular disease. During deep sedation, the consultants agree that a defibrillator should be immediately available for all patients.
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Recommendations.
Pharmacologic antagonists as well as appropriately sized equipment for establishing a patent airway and providing positive pressure ventilation with supplemental oxygen should be present whenever sedation–analgesiais administered. Suction, advanced airway equipment, and resuscitation medications should be immediately available and in good working order (Example III). A functional defibrillator should be immediately available whenever deep sedation is administered and when moderate sedation is administered to patients with mild or severe cardiovascular disease.
Table. Example III.E...
Table. Example III.E...
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TABLE
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Use of Supplemental Oxygen
The literature supports the use of supplemental oxygen during moderate sedation and suggests that supplemental oxygen be used during deep sedation to reduce the frequency of hypoxemia. The consultants agree that supplemental oxygen decreases patient risk during moderate sedation, while strongly agreeing with this view for deep sedation.
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Recommendations.
Equipment to administer supplemental oxygen should be present when sedation/analgesia is administered. Supplemental oxygen should be considered for moderate sedation and should be administered during deep sedation unless specifically contraindicated for a particular patient or procedure. If hypoxemia is anticipated or develops during sedation/analgesia, supplemental oxygen should be administered.
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Combinations of Sedative–Analgesic Agents
The literature suggests that combining a sedative with an opioid provides effective moderate sedation; it is equivocal regarding whether the combination of a sedative and an opioid may be more effective than a sedative or an opioid alone in providing adequate moderate sedation. For deep sedation, the literature is insufficient to compare the efficacy of sedative–opioid combinations with that of a sedative alone. The consultants agree that combinations of sedatives and opioids provide satisfactory moderate and deep sedation. However, the published data also suggest that combinations of sedatives and opioids may increase the likelihood of adverse outcomes, including ventilatory depression and hypoxemia; the consultants were equivocal on this issue for both moderate and deep sedation. It is the consensus of the Task Force that fixed combinations of sedative and analgesic agents may not allow the individual components of sedation/analgesia to be appropriately titrated to meet the individual requirements of the patient and procedure while reducing the associated risks.
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Recommendations.
Combinations of sedative and analgesic agents may be administered as appropriate for the procedure being performed and the condition of the patient. Ideally, each component should be administered individually to achieve the desired effect (e.g., additional analgesic medication to relieve pain; additional sedative medication to decrease awareness or anxiety). The propensity for combinations of sedative and analgesic agents to cause respiratory depression and airway obstruction emphasizes the need to appropriately reduce the dose of each component as well as the need to continually monitor respiratory function.
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Titration of Intravenous Sedative–Analgesic Medications
The literature is insufficient to determine whether administration of small, incremental doses of intravenous sedative/analgesic drugs until the desired level of sedation or analgesia is achieved is preferable to a single dose based on patient size, weight, or age. The consultants strongly agree that incremental drug administration improves patient comfort and decreases risks for both moderate and deep sedation.
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Recommendations.
Intravenous sedative/analgesic drugs should be given in small, incremental doses that are titrated to the desired end points of analgesia and sedation. Sufficient time must elapse between doses to allow the effect of each dose to be assessed before subsequent drug administration. When drugs are administered by nonintravenous routes (e.g., oral, rectal, intramuscular, transmucosal), allowance should be made for the time required for drug absorption before supplementation is considered. Because absorption may be unpredictable, administration of repeat doses of oral medications to supplement sedation/analgesia is not recommended.
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Anesthetic Induction Agents Used for Sedation/Analgesia (Propofol, Methohexital, Ketamine)
The literature suggests that, when administered by non-anesthesiologists, propofol and ketamine can provide satisfactory moderate sedation, and suggests that methohexital can provide satisfactory deep sedation. The literature is insufficient to evaluate the efficacy of propofol or ketamine administered by non-anesthesiologists for deep sedation. There is insufficient literature to determine whether moderate or deep sedation with propofol is associated with a different incidence of adverse outcomes than similar levels of sedation with midazolam. The consultants are equivocal regarding whether use of these medications affects the likelihood of producing satisfactory moderate sedation, while agreeing that using them increases the likelihood of satisfactory deep sedation. However, the consultants agree that avoiding these medications decreases the likelihood of adverse outcomes during moderate sedation and are equivocal regarding their effect on adverse outcomes during deep sedation.
The Task Force cautions practitioners that methohexital and propofol can produce rapid, profound decreases in level of consciousness and cardiorespiratory function, potentially culminating in a state of general anesthesia. The Task Force notes that ketamine also produces dose-related decreases in level of consciousness, culminating in general anesthesia. Although it may be associated with less cardiorespiratory depression than other sedatives, airway obstruction, laryngospasm, and pulmonary aspiration may still occur with ketamine. Furthermore, because of its dissociative properties, some of the usual signs of depth of sedation may not apply (e.g., the patient's eyes may be open while in a state of deep sedation or general anesthesia). The Task Force also notes that there are no specific pharmacologic antagonists for any of these medications.
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Recommendations.
Even if moderate sedation is intended, patients receiving propofol or methohexital by any route should receive care consistent with that required for deep sedation. Accordingly, practitioners administering these drugs should be qualified to rescue patients from any level of sedation, including general anesthesia. Patients receiving ketamine should be cared for in a manner consistent with the level of sedation that is achieved.
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Intravenous Access
Published literature is equivocal regarding the relative efficacy of sedative–analgesic agents administered intravenously as compared with those administered by nonintravenous routes to achieve moderate sedation; the literature is insufficient on this issue for deep sedation. The literature is equivocal regarding the comparative safety of these routes of administration for moderate sedation and is insufficient for deep sedation. The consultants strongly agree that intravenous administration of sedative and analgesic medications increases the likelihood of satisfactory sedation for both moderate and deep sedation. They also agree that it decreases the likelihood of adverse outcomes. For both moderate and deep sedation, when sedative–analgesic medications are administered intravenously, the consultants strongly agree with maintaining intravenous access until patients are no longer at risk for cardiovascular or respiratory depression, because it increases the likelihood of satisfactory sedation and decreases the likelihood of adverse outcomes. In situations where sedation is initiated by nonintravenous routes (e.g., oral, rectal, intramuscular), the need for intravenous access is not sufficiently addressed in the literature. However, initiation of intravenous access after the initial sedation takes effect allows additional sedative–analgesic and resuscitation drugs to be administered if necessary.
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Recommendations.
In patients receiving intravenous medications for sedation/analgesia, vascular access should be maintained throughout the procedure and until the patient is no longer at risk for cardiorespiratory depression. In patients who have received sedation–analgesia by nonintravenous routes, or whose intravenous line has become dislodged or blocked, practitioners should determine the advisability of establishing or reestablishing intravenous access on a case-by-case basis. In all instances, an individual with the skills to establish intravenous access should be immediately available.
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Reversal Agents
Specific antagonist agents are available for the opioids (e.g., naloxone) and benzodiazepines (e.g., flumazenil). The literature supports the ability of naloxone to reverse opioid-induced sedation and respiratory depression. Practitioners are cautioned that acute reversal of opioid-induced analgesia may result in pain, hypertension, tachycardia, or pulmonary edema. The literature supports the ability of flumazenil to antagonize benzodiazepine-induced sedation and ventilatory depression in patients who have received benzodiazepines alone or in combination with an opioid. The consultants strongly agree that the immediate availability of reversal agents during both moderate and deep sedation is associated with decreased risk of adverse outcomes. It is the consensus of the Task Force that respiratory depression should be initially treated with supplemental oxygen and, if necessary, positive pressure ventilation by mask. The consultants disagree that the use of sedation regimens that are likely to require routine reversal with flumazenil or naloxone improves the quality of sedation or reduces the risk of adverse outcomes.
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Recommendations.
Specific antagonists should be available whenever opioid analgesics or benzodiazepines are administered for sedation/analgesia. Naloxone or flumazenil may be administered to improve spontaneous ventilatory efforts in patients who have received opioids or benzodiazepines, respectively. This may be especially helpful in cases where airway control and positive pressure ventilation are difficult. Before or concomitantly with pharmacologic reversal, patients who become hypoxemic or apneic during sedation/analgesia should: (1) be encouraged or stimulated to breathe deeply; (2) receive supplemental oxygen; and (3) receive positive pressure ventilation if spontaneous ventilation is inadequate. After pharmacologic reversal, patients should be observed long enough to ensure that sedation and cardiorespiratory depression does not recur once the effect of the antagonist dissipates. The use of sedation regimens that include routine reversal of sedative or analgesic agents is discouraged.
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Recovery Care
Patients may continue to be at significant risk for developing complications after their procedure is completed. Decreased procedural stimulation, delayed drug absorption following nonintravenous administration, and slow drug elimination may contribute to residual sedation and cardiorespiratory depression during the recovery period. Examples include intramuscular meperidine–promethazine–chlorpromazine mixtures and oral or rectal chloral hydrate. When sedation–analgesia is administered to outpatients, it is likely that there will be no medical supervision once the patient leaves the medical facility. Although there is not sufficient literature to examine the effects of postprocedure monitoring on patient outcomes, the consultants strongly agree that continued observation, monitoring, and predetermined discharge criteria decrease the likelihood of adverse outcomes for both moderate and deep sedation. It is the consensus of the Task Force that discharge criteria should be designed to minimize the risk for cardiorespiratory depression after patients are released from observation by trained personnel.
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Recommendations.
Following sedation/analgesia, patients should be observed in an appropriately staffed and equipped area until they are near their baseline level of consciousness and are no longer at increased risk for cardiorespiratory depression. Oxygenation should be monitored periodically until patients are no longer at risk for hypoxemia. Ventilation and circulation should be monitored at regular intervals until patients are suitable for discharge. Discharge criteria should be designed to minimize the risk of central nervous system or cardiorespiratory depression after discharge from observation by trained personnel (Example IV).
Table. Example IV.Re...
Table. Example IV.Re...
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TABLE
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Special Situations
The literature suggests and the Task Force members concur that certain types of patients are at increased risk for developing complications related to sedation/analgesia unless special precautions are taken. In patients with significant underlying medical conditions (e.g., extremes of age; severe cardiac, pulmonary, hepatic, or renal disease; pregnancy; drug or alcohol abuse) the consultants agree that preprocedure consultation with an appropriate medical specialist (e.g., cardiologist, pulmonologist) decreases the risks associated with moderate sedation and strongly agree that it decreases the risks associated with deep sedation. In patients with significant sedation-related risk factors (e.g., uncooperative patients, morbid obesity, potentially difficult airway, sleep apnea), the consultants are equivocal regarding whether preprocedure consultation with an anesthesiologist increases the likelihood of satisfactory moderate sedation, while agreeing that it decreases adverse outcomes. The consultants strongly agree that preprocedure consultation increases the likelihood of satisfactory outcomes while decreasing risks associated with deep sedation. The Task Force notes that in emergency situations, the benefits of awaiting preprocedure consultations must be weighed against the risk of delaying the procedure.
For moderate sedation, the consultants are equivocal regarding whether the immediate availability of an individual with postgraduate training in anesthesiology increases the likelihood of a satisfactory outcome or decreases the associated risks. For deep sedation, the consultants agree that the immediate availability of such an individual improves the likelihood of satisfactory sedation and that it will decrease the likelihood of adverse outcomes.
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Recommendations.
Whenever possible, appropriate medical specialists should be consulted before administration of sedation to patients with significant underlying conditions. The choice of specialists depends on the nature of the underlying condition and the urgency of the situation. For severely compromised or medically unstable patients (e.g., anticipated difficult airway, severe obstructive pulmonary disease, coronary artery disease, or congestive heart failure), or if it is likely that sedation to the point of unresponsiveness will be necessary to obtain adequate conditions, practitioners who are not trained in the administration of general anesthesia should consult an anesthesiologist.
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FOOTNOTES

†Readers with special interest in the statistical analysis used in establishing these Guidelines can receive further information by writing to the American Society of Anesthesiologists: 520 N. Northwest Highway, Park Ridge, Illinois 60068-2573. Cited Here...
‡This is a summary of the Guidelines. The body of the document should be consulted for complete details. Cited Here...
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Appendix I: Methods and Analyses
The scientific assessment of these Guidelines was based on the following statements or evidence linkages. These linkages represent directional statements about relationships between sedation/analgesia interventions by non-anesthesiologists and clinical outcomes.
1. A preprocedure patient evaluation, (i.e., history, physical examination, laboratory evaluation, consultation)
2. a. Improves clinical efficacy (i.e., satisfactory sedation and analgesia)
3. b. Reduces adverse outcomes
4. Preprocedure preparation of the patient (e.g., counseling, fasting)
5. a. Improves clinical efficacy (i.e., satisfactory sedation and analgesia)
6. b. Reduces adverse outcomes
7. Patient monitoring (i.e., level of consciousness, pulmonary ventilation [observation, auscultation], oxygenation [pulse oximetry], automated apnea monitoring [capnography], hemodynamics [electrocardiogram, blood pressure, heart rate])
8. a. Improves clinical efficacy (i.e., satisfactory sedation and analgesia)
9. b. Reduces adverse outcomes
10. Contemporaneous recording of monitored parameters (e.g., level of consciousness, respiratory function, hemodynamics) at regular intervals in patients receiving sedation or analgesia
11. a. Improves clinical efficacy (i.e., satisfactory sedation and analgesia)
12. b. Reduces adverse outcomes
13. Availability of an individual who is dedicated solely to patient monitoring and safety
14. a. Improves clinical efficacy (i.e., satisfactory sedation and analgesia)
15. b. Reduces adverse outcomes
16. Education and training of sedation and analgesia providers in the pharmacology of sedation–analgesia agents
17. a. Improves clinical efficacy (i.e., satisfactory sedation and analgesia)
18. b. Reduces adverse outcomes
19. The presence of an individual(s) capable of establishing a patent airway, positive pressure ventilation, and resuscitation (i.e., advanced life-support skills) during a procedure
20. a. Improves clinical efficacy (i.e., satisfactory sedation and analgesia)
21. b. Reduces adverse outcomes
22. Availability of appropriately sized emergency and airway equipment (e.g., laryngeal mask airway, defibrillators)
23. a. Improves clinical efficacy (i.e., satisfactory sedation and analgesia)
24. b. Reduces adverse outcomes
25. The use of supplemental oxygen during procedures performed with sedation or analgesia
26. a. Improves clinical efficacy (i.e., satisfactory sedation and analgesia)
27. b. Reduces adverse outcomes
28. Use of sedative agents combined with analgesic agents (e.g., sedative–analgesic cocktails, fixed combinations of sedatives and analgesics, titrated combinations of sedatives and analgesics)
29. a. Improves clinical efficacy (i.e., satisfactory sedation and analgesia)
30. b. Reduces adverse outcomes
31. Titration of intravenous sedative–analgesic medications to achieve the desired effect
32. a. Improves clinical efficacy (i.e., satisfactory sedation and analgesia)
33. b. Reduces adverse outcomes
34. Intravenous sedation–analgesic medications specifically designed to be used for general anesthesia (i.e., methohexital, propofol, and ketamine)
35. a. Improves clinical efficacy (i.e., satisfactory sedation and analgesia)
36. b. Reduces adverse outcomes
37. Administration of sedative–analgesic agents by the intravenous route
38. a. Improves clinical efficacy (i.e., satisfactory sedation and analgesia)
39. b. Reduces adverse outcomes
40. Maintaining or establishing intravenous access during sedation or analgesia until the patient is no longer at risk for cardiorespiratory depression
41. a. Improves clinical efficacy (i.e., satisfactory sedation and analgesia)
42. b. Reduces adverse outcomes
43. Availability of reversal agents (naloxone and flumazenil only) for the sedative or analgesic agents being administered
44. a. Improves clinical efficacy (i.e., satisfactory sedation and analgesia)
45. b. Reduces adverse outcomes
46. Postprocedural recovery observation, monitoring, and predetermined discharge criteria reduce adverse outcomes.
47. Special regimens (e.g., preprocedure consultation, specialized monitoring, special sedatives–techniques) for patients with special problems (e.g., uncooperative patients; extremes of age; severe cardiac, pulmonary, hepatic, renal, or central nervous system disease; morbid obesity; sleep apnea; pregnancy; drug or alcohol abuse; emergency–unprepared patients; metabolic and airway difficulties)
48. a. Improves clinical efficacy (i.e., satisfactory sedation and analgesia)
49. b. Reduces adverse outcomes
Scientific evidence was derived from aggregated research literature and from surveys, open presentations, and other consensus-oriented activities. For purposes of literature aggregation, potentially relevant clinical studies were identified via electronic and manual searches of the literature. The electronic search covered a 36-yr period from 1966 through 2001. The manual search covered a 44-yr period from 1958 through 2001. More than 3,000 citations were initially identified, yielding a total of 1,876 nonoverlapping articles that addressed topics related to the 15 evidence linkages. After review of the articles, 1,519 studies did not provide direct evidence and were subsequently eliminated. A total of 357 articles contained direct linkage-related evidence.
A directional result for each study was initially determined by a literature count, classifying each outcome as either supporting a linkage, refuting a linkage, or neutral. The results were then summarized to obtain a directional assessment of support for each linkage. Literature pertaining to three evidence linkages contained enough studies with well-defined experimental designs and statistical information to conduct formal metaanalyses. These three linkages were: linkage 8 [supplemental oxygen], linkage 9 [benzodiazepines combined with opioids vs. benzodiazepines alone], and linkage 13 [naloxone for antagonism of opioids, flumazenil for antagonism of benzodiazepines, and flumazenil for antagonism of benzodiazepine-opioid combinations].
Combined probability tests were applied to continuous data, and an odds-ratio procedure was applied to dichotomous study results. Two combined probability tests were employed as follows: (1) the Fisher combined test, producing chi-square values based on logarithmic transformations of the reported P values from the independent studies; and (2) the Stouffer combined test, providing weighted representation of the studies by weighting each of the standard normal deviates by the size of the sample. An odds-ratio procedure based on the Mantel–Haenszel method for combining study results using 2 × 2 tables was used with outcome frequency information. An acceptable significance level was set at P < 0.01 (one-tailed), and effect size estimates were calculated. Tests for heterogeneity of the independent studies were conducted to assure consistency among the study results. Der Simonian-Laird random-effects odds ratios were calculated when significant heterogeniety was found. To assess potential publishing bias, a “fail-safe N” value was calculated for each combined probability test. No search for unpublished studies was conducted, and no reliability tests for locating research results were performed.
Table 2
Table 2
Image Tools
Metaanalytic results are reported in table 2. The following outcomes were found to be significant for combined probability tests: (1) oxygen saturation, linkage 8 (supplemental oxygen); (2) sedation recovery, linkage 13 (naloxone for antagonism of opioids and flumazenil for antagonism of benzodiazepine–opioid combinations); (3) psychomotor recovery, linkage 13 (flumazenil for antagonism of benzodiazepines); and (4) respiratory–ventilatory recovery, linkage 13 (naloxone for antagonism of opioids, flumazenil for antagonism of benzodiazepines, and flumazenil for antagonism of benzodiazepine–opioid combinations). To be considered acceptable findings of significance, both the Fisher and weighted Stouffer combined test results must agree. Weighted effect size values for these linkages ranged from r = 0.19 to 0.80, representing moderate to high effect size estimates.
Mantel–Haenszel odds ratios were significant for the following outcomes: (1) hypoxemia, linkage 8 (supplemental oxygen) and linkage 9 (benzodiazepine–opioid combinations vs. benzodiazepines alone); (2) sedation recovery, linkage 13 (flumazenil for antagonism of benzodiazepines); and (3) recall of procedure, linkage 9 (benzodiazepine–opioid combinations). To be considered acceptable findings of significance, Mantel–Haenszel odds ratios must agree with combined test results when both types of data are assessed.
Interobserver agreement among Task Force members and two methodologists was established by interrater reliability testing. Agreement levels using a Kappa (κ) statistic for two-rater agreement pairs were as follows: (1) type of study design, κ = 0.25–0.64; (2) type of analysis, κ = 0.36–0.83; (3) evidence linkage assignment, κ = 0.78–0.89; and (4) literature inclusion for database, κ = 0.71–1.00. Three-rater chance-corrected agreement values were: (1) study design, Sav = 0.45, Var (Sav) = 0.012; (2) type of analysis, Sav = 0.51, Var (Sav) = 0.015; (3) linkage assignment, Sav = 0.81 Var (Sav) = 0.006; (4) literature database inclusion, Sav = 0.84 Var (Sav) = 0.046. These values represent moderate to high levels of agreement.
Table 3
Table 3
Image Tools
The findings of the literature analyses were supplemented by the opinions of Task Force members as well as by surveys of the opinions of a panel of consultants drawn from the following specialties where sedation and analgesia are commonly administered: Anesthesiology, 8; Cardiology, 2; Dental Anesthesiology, 3; Dermatology, 2; Emergency Medicine, 5; Gastroenterology, 9; Intensive Care, 1; Oral and Maxillofacial Surgery, 5; Pediatrics, 1; Pediatric Dentistry, 3; Pharmacology, 1; Pulmonary Medicine, 3; Radiology, 3; Surgery, 3; and Urology, 2. The rate of return for this Consultant survey was 78% (n = 51/65). Median agreement scores from the Consultants regarding each linkage are reported in table 3.
For moderate sedation, Consultants were supportive of all of the linkages with the following exceptions: linkage 3 (electrocardiogram monitoring and capnography), linkage 9 (sedatives combined with analgesics for reducing adverse outcomes), linkage 11 (avoiding general anesthesia sedatives for improving satisfactory sedation), linkage 13b (routine administration of naloxone), linkage 13c (routine administration of flumazenil), and linkage 15b (anesthesiologist consultation for patients with medical conditions to provide satisfactory moderate sedation). In addition, Consultants were equivocal regarding whether postgraduate training in anesthesiology improves moderate sedation or reduces adverse outcomes.
For deep sedation, Consultants were supportive of all of the linkages with the following exceptions: linkage 9 (sedatives combined with analgesics for reducing adverse outcomes), linkage 11 (avoiding general anesthesia sedatives), linkage 13b (routine administration of naloxone), and linkage 13c (routine administration of flumazenil).
The Consultants were asked to indicate which, if any, of the evidence linkages would change their clinical practices if the updated Guidelines were instituted. The rate of return was 57% (n = 37/65). The percent of responding Consultants expecting no change associated with each linkage were as follows: preprocedure patient evaluation, 94%; preprocedure patient preparation, 91%; patient monitoring, 80%; contemporaneous recording of monitored parameters, 91%; availability of individual dedicated solely to patient monitoring and safety, 91%; education and training of sedation–analgesia providers in pharmacology, 89%; presence of an individual(s) capable of establishing a patent airway, 91%; availability of appropriately sized emergency and airway equipment, 94%; use of supplemental oxygen during procedures, 100%; use of sedative agents combined with analgesic agents, 91%; titration of sedatives–analgesics, 97%; intravenous sedation–analgesia with agents designed for general anesthesia, 77%; administration of sedative–analgesic agents by the intravenous route, 94%; maintaining or establishing intravenous access, 97%; availability–use of flumazenil, 94%; availability–use of naloxone, 94%; observation and monitoring during recovery, 89%; special care for patients with underlying medical problems, 91%; and special care for uncooperative patients, 94%. Seventy-four percent of the respondents indicated that the Guidelines would have no effect on the amount of time spent on a typical case. Nine respondents (26%) indicated that there would be an increase in the amount of time they would spend on a typical case with the implementation of these Guidelines. The amount of increased time anticipated by these respondents ranged from 1 to 60 min.
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Appendix II: Summary of Guidelines
Except as noted, recommendations apply to both moderate and deep sedation.
1. Preprocedure evaluation
2. Relevant history (major organ systems, sedation–anesthesia history, medications, allergies, last oral intake)
3. Focused physical examination (to include heart, lungs, airway)
4. Laboratory testing guided by underlying conditions and possible effect on patient management
5. Findings confirmed immediately before sedation
6. Patient counseling
7. Risks, benefits, limitations, and alternatives
8. Preprocedure fasting
9. Elective procedures—sufficient time for gastric emptying
10. Urgent or emergent situations—potential for pulmonary aspiration considered in determining target level of sedation, delay of procedure, protection of trachea by intubation
11. See ASA Guidelines for Preoperative Fasting 2
12. Monitoring
13. (Data to be recorded at appropriate intervals before, during, and after procedure)
14. Pulse oximetry
15. Response to verbal commands when practical
16. Pulmonary ventilation (observation, auscultation)
17. Exhaled carbon dioxide monitoring considered when patients separated from caregiver
18. Blood pressure and heart rate at 5-min intervals unless contraindicated
19. Electrocardiograph for patients with significant cardiovascular disease
20. For deep sedation:
21. Response to verbal commands or more profound stimuli unless contraindicated
22. Exhaled CO2 monitoring considered for all patients
23. Electrocardiograph for all patients
24. Personnel
25. Designated individual, other than the practitioner performing the procedure, present to monitor the patient throughout the procedure
26. This individual may assist with minor interruptible tasks once patient is stable
27. For deep sedation:
28. The monitoring individual may not assist with other tasks
29. Training
30. Pharmacology of sedative and analgesic agents
31. Pharmacology of available antagonists
32. Basic life support skills—present
33. Advanced life support skills—within 5 min
34. For deep sedation:
35. Advanced life support skills in the procedure room
36. Emergency Equipment
37. Suction, appropriately sized airway equipment, means of positive-pressure ventilation
38. Intravenous equipment, pharmacologic antagonists, and basic resuscitative medications
39. Defibrillator immediately available for patients with cardiovascular disease
40. For deep sedation:
41. Defibrillator immediately available for all patients
42. Supplemental Oxygen
43. Oxygen delivery equipment available
44. Oxygen administered if hypoxemia occurs
45. For deep sedation:
46. Oxygen administered to all patients unless contraindicated
47. Choice of Agents
48. Sedatives to decrease anxiety, promote somnolence
49. Analgesics to relieve pain
50. Dose Titration
51. Medications given incrementally with sufficient time between doses to assess effects
52. Appropriate dose reduction if both sedatives and analgesics used
53. Repeat doses of oral medications not recommended
54. Use of anesthetic induction agents (methohexital, propofol)
55. Regardless of route of administration and intended level of sedation, patients should receive care consistent with deep sedation, including ability to rescue from unintended general anesthesia
56. Intravenous Access
57. Sedatives administered intravenously—maintain intravenous access
58. Sedatives administered by other routes—case-by-case decision
59. Individual with intravenous skills immediately available
60. Reversal Agents
61. Naloxone and flumazenil available whenever opioids or benzodiazepines administered
62. Recovery
63. Observation until patients no longer at risk for cardiorespiratory depression
64. Appropriate discharge criteria to minimize risk of respiratory or cardiovascular depression after discharge
65. Special Situations
66. Severe underlying medical problems—consult with appropriate specialist if possible
67. Risk of severe cardiovascular or respiratory compromise or need for complete unresponsiveness to obtain adequate operating conditions—consult anesthesiologist
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References

1. Practice Guidelines for sedation and analgesia by non-anesthesiologists: A report by the American Society of Anesthesiologists Task Force on Sedation and Analgesia by Non-Anesthesiologists. A nesthesiology 1996; 84: 459–71

2. Practice Guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: application to healthy patients undergoing elective procedures: A report by the American Society of Anesthesiologist Task Force on Preoperative Fasting. A nesthesiology 1999; 90: 896–905

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Journal of Clinical Epidemiology, 61(9): 882-889.
10.1016/j.jclinepi.2007.10.015
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Gastrointestinal Endoscopy
An assessment of computer-assisted personalized sedation: a sedation delivery system to administer propofol for gastrointestinal endoscopy
Pambianco, DJ; Whitten, CJ; Moerman, A; Struys, MM; Martin, JF
Gastrointestinal Endoscopy, 68(3): 542-547.
10.1016/j.gie.2008.02.011
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Gastrointestinal Endoscopy
Sedation and anesthesia in GI endoscopy (Reprinted from Gastroenterology, vol 133, pg 675-501, 2007)
Lichtenstein, DR; Jagannath, S; Baron, TH; Anderson, MA; Banerjee, S; Dominitz, JA; Fanelli, RD; Gan, SI; Harrison, ME; Ikenberry, SO; Shen, B; Stewart, L; Khan, K; Vargo, JJ
Gastrointestinal Endoscopy, 68(5): 815-826.
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Canadian Journal of Emergency Medicine
Efficacy, safety and patient satisfaction of propofol for procedural sedation and analgesia in the emergency department: a prospective study
Zed, PJ; Abu-Laban, RB; Chan, WWY; Harrison, DW
Canadian Journal of Emergency Medicine, 9(6): 421-427.

Surgical Endoscopy and Other Interventional Techniques
Analysis of 153 deaths after upper gastrointestinal endoscopy: room for improvement?
Thompson, AM; Wright, DJ; Murray, W; Ritchie, GL; Burton, HD; Stonebridge, PA
Surgical Endoscopy and Other Interventional Techniques, 18(1): 22-25.
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Gastrointestinal Endoscopy
Cardiovascular complications after GI endoscopy: occurrence and risks in a large hospital system
Gangi, S; Saidi, F; Patel, K; Johnstone, B; Jaeger, J; Shine, D
Gastrointestinal Endoscopy, 60(5): 679-685.
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Lancet
Procedural sedation and analgesia in children
Krauss, B; Green, SM
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Endoscopy
Propofol sedation during endoscopic procedures: Safe and effective administration by registered nurses supervised by endoscopists
Tohda, G; Higashi, S; Wakahara, S; Morikawa, M; Sakumoto, H; Kane, T
Endoscopy, 38(4): 360-367.
10.1055/s-2005-921192
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Pace-Pacing and Clinical Electrophysiology
Sedation with midazolam for electrical cardioversion
Notarstefano, P; Pratola, C; Toselli, T; Baldo, E; Ferrari, R
Pace-Pacing and Clinical Electrophysiology, 30(5): 608-611.

Pediatric Anesthesia
Intraoperative reported adverse events in children
Kakavouli, A; Li, GH; Carson, MP; Sobol, J; Lin, C; Ohkawa, S; Huang, L; Galiza, C; Wood, A; Sun, LS
Pediatric Anesthesia, 19(8): 732-739.
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Anesthesia and Analgesia
Dental Sedation by Dentists: A View From Anesthesiologists Working in Central Western Brazil
Costa, PSS; Valadao, WJ; Costa, LRRS
Anesthesia and Analgesia, 110(1): 110-114.
10.1213/ANE.0b013e3181bdc63d
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Digestion
Sedation in Gastrointestinal Endoscopy: An Anesthesiologist's Perspective
Van der Linden, P
Digestion, 82(2): 102-105.
10.1159/000285525
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Digestion
Elements of Airway Training
Arnaoutoglou, E
Digestion, 82(2): 118-120.
10.1159/000285653
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Anasthesiologie & Intensivmedizin
Sedation for diagnosis and therapeutic measures in adults
Van Aken, H; Biermann, E; Martin, J; Mertens, E; Prien, T; Landauer, B; Roewer, N; Schulte-Sasse, U; Sorgatz, H; Strauss, J; Tarnow, J
Anasthesiologie & Intensivmedizin, 51(): S598-S602.

Annals of Emergency Medicine
Preprocedural fasting state and adverse events in children undergoing procedural sedation and analgesia in a pediatric emergency department
Agrawal, D; Manzi, SF; Gupta, R; Krauss, B
Annals of Emergency Medicine, 42(5): 636-646.
10.1067/mem.2003.331
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British Journal of Hospital Medicine
Sedation for procedures in children: a guide for the non-anaesthetist
Sury, MRJ
British Journal of Hospital Medicine, 67(1): 29-33.

Pediatric Clinics of North America
Pediatric procedural sedation and analgesia
Doyle, L; Colletti, JE
Pediatric Clinics of North America, 53(2): 279-+.
10.1016/j.pcl.2005.09.008
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Indian Pediatrics
Painless procedures in pediatrics: Pipe dream or a possibility?
Shankar, V
Indian Pediatrics, 43(4): 295-300.

Korean Journal of Radiology
Safety and effectiveness of moderate sedation for radiologic non-vascular intervention
Kim, TH
Korean Journal of Radiology, 7(2): 125-130.

Emergency Medicine Journal
Sedation practice in a Scottish teaching hospital emergency department
Duncan, RA; Symington, L; Thakore, S
Emergency Medicine Journal, 23(9): 684-686.
10.1136/emj.2006.035220
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Gastrointestinal Endoscopy
A systematic review and meta-analysis of randomized, controlled trials of moderate sedation for routine endoscopic procedures
McQuaid, KR; Laine, L
Gastrointestinal Endoscopy, 67(6): 910-923.
10.1016/j.gie.2007.12.046
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Clinical Gastroenterology and Hepatology
Capnography and Patient Safety for Endoscopy
Gerstenberger, PD
Clinical Gastroenterology and Hepatology, 8(5): 423-425.
10.1016/j.cgh.2010.02.024
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Gastrointestinal Endoscopy
Obstructive sleep apnea: can we gauge risk?
Pambianco, DJ
Gastrointestinal Endoscopy, 71(7): 1231-1233.
10.1016/j.gie.2010.01.061
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Gastroenterology
Propofol for conscious sedation?
Byrne, MF; Baillie, J
Gastroenterology, 123(1): 373-375.
10.1053/gast.2002.34452
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Journal of Pediatrics
A pediatric sedation/anesthesia program with dedicated care by anesthesiologists and nurses for procedures outside the operating room
Gozal, D; Drenger, B; Levin, PD; Kadari, A; Gozal, Y
Journal of Pediatrics, 145(1): 47-52.
10.1016/j.jpeds.2004.01.044
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Pediatric Annals
Strategies for preventing sedation accidents
Cote, CJ
Pediatric Annals, 34(8): 625-633.

Pediatric Emergency Care
Preprocedural fasting state and adverse events in children receiving nitrous oxide for procedural sedation and analgesia
Babl, FE; Puspitadewi, A; Barnett, P; Oakley, E; Spicer, M
Pediatric Emergency Care, 21(): 736-743.

Annals of Emergency Medicine
The utility of supplemental oxygen during emergency department procedural sedation with propofol: A randomized, controlled trial
Deitch, K; Chudnofsky, CR; Dominici, P
Annals of Emergency Medicine, 52(1): 1-8.
10.1016/j.annemergmed.2007.11.040
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Notarzt
Fundamentals of practical pain management in pediatric emergency situations
Annetzberger, P
Notarzt, 24(4): 117-123.
10.1055/s-2008-1067342
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Gastrointestinal Endoscopy
On computers, nurses, and propofol: further evidence for the jury?
Iravani, M
Gastrointestinal Endoscopy, 68(3): 510-512.
10.1016/j.gie.2008.04.056
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Anesthesia and Analgesia
Growth Rates in Pediatric Diagnostic Imaging and Sedation
Wachtel, RE; Dexter, F; Dow, AJ
Anesthesia and Analgesia, 108(5): 1616-1621.
10.1213/ane.0b013e3181981f96
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Pediatrics
The American College of Chest Physicians Consensus Statement on the Respiratory and Related Management of Patients With Duchenne Muscular Dystrophy Undergoing Anesthesia or Sedation
Birnkrant, DJ
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10.1542/peds.2008-2952J
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Digestion
Basic Requirements for Monitoring Sedated Patients: Blood Pressure, Pulse Oximetry, and EKG
Maurer, WG; Walsh, M; Viazis, N
Digestion, 82(2): 87-89.
10.1159/000285505
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Annals of Saudi Medicine
The underuse of analgesia and sedation in pediatric emergency medicine
Razzaq, Q
Annals of Saudi Medicine, 26(5): 375-381.

Anaesthesist
Anaesthesia for cardiac catheterization in children
Velik-Salchner, C; Margreiter, J; Wenzel, V; Mair, P
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10.1007/s00101-006-1105-5
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Annals of Emergency Medicine
The utility of supplemental oxygen during emergency department procedural sedation and analgesia with midazolam and fentanyl: A randomized, controlled trial
Deitch, K; Chudnofsky, CR; Dominici, P
Annals of Emergency Medicine, 49(1): 1-8.
10.1016/j.annemergmed.2006.06.013
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Annals of Emergency Medicine
Clinical practice advisory: Emergency department procedural sedation with propofol
Miner, JR; Burton, JH
Annals of Emergency Medicine, 50(2): 182-187.
10.1016/j.annemergmed.2006.12.017
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Archives of Pediatrics & Adolescent Medicine
Enhancing patient safety during pediatric sedation - The impact of simulation-based training of nonanesthesiologists
Shavit, I; Keidan, I; Hoffmann, Y; Mishuk, L; Rubin, O; Ziv, A; Steiner, IP
Archives of Pediatrics & Adolescent Medicine, 161(8): 740-743.

Drugs & Aging
Monitored anaesthesia care in the elderly - Guidelines and recommendations
Ekstein, M; Gavish, D; Ezri, T; Weinbroum, AA
Drugs & Aging, 25(6): 477-500.

Pediatrics
Conscious sedation of children with propofol is anything but conscious
Reeves, ST; Havidich, JE; Tobin, DP
Pediatrics, 114(1): E74-E76.

American Journal of Gastroenterology
Propofol may be safely administered by trained nonanesthesiologists - PRO: Propofol demystifield: It is time to change the sedation paradigm
Vargo, JJ
American Journal of Gastroenterology, 99(7): 1207-1208.

Radiographics
Fast STIR whole-body MR imaging in children
Kellenberger, CJ; Epelman, M; Miller, SF; Babyn, PS
Radiographics, 24(5): 1317-1330.

Mayo Clinic Proceedings
Comparison of electrophysiologic monitors with clinical assessment of level of sedation
Chisholm, CJ; Zurica, J; Mironov, D; Sciacca, RR; Ornstein, E; Heyer, EJ
Mayo Clinic Proceedings, 81(1): 46-52.

Journal of Pediatric Hematology Oncology
Attitudes of children with leukemia toward repeated deep sedations with propofol
Barbi, E; Badina, L; Marchetti, F; Vecchi, R; Giuseppin, I; Bruno, I; Zanazzo, G; Sarti, A; Ventura, A
Journal of Pediatric Hematology Oncology, 27(): 639-643.

Endoscopy
Efficacy and safety of nurse-administered propofol sedation during emergency upper endoscopy for gastrointestinal bleeding: a prospective study
Tohda, G; Higashi, S; Sakumoto, H; Sumiyoshi, K; Kane, T
Endoscopy, 38(7): 684-689.
10.1055/s-2006-925374
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American Journal of Gastroenterology
Nurse-administered propofol sedation without anesthesia specialists in 9152 endoscopic cases in an ambulatory surgery center
Walker, JA; McIntyre, RD; Schleinitz, PF; Jacobson, KN; Haulk, AA; Adesman, P; Tolleson, S; Parent, R; Donnelly, R; Rex, DK
American Journal of Gastroenterology, 98(8): 1744-1750.
10.1016/S0002-9270(03)00496-9
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Journal of Vascular and Interventional Radiology
Postprocedure pain management of interventional radiology patients
Hatsiopoulou, O; Cohen, RI; Lang, EV
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10.1097/01.RVI.0000085769.63355.24
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British Journal of Anaesthesia
Implicit memory formation in sedated ICU patients after cardiac surgery
Clark, J; Voss, L; Barnard, J; Sleigh, J
British Journal of Anaesthesia, 91(6): 810-814.
10.1093/bja/aeg274
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Annals of Emergency Medicine
Bispectral index monitoring quantifies depth of sedation during emergency department procedural sedation and analgesia in children
Agrawal, D; Feldman, HA; Krauss, B; Waltzman, ML
Annals of Emergency Medicine, 43(2): 247-255.
10.1016/mem.2004.400
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Digestion
The dawning of a new sedative: Propofol in gastrointestinal endoscopy
Heuss, LT; Inauen, W
Digestion, 69(1): 20-26.
10.1159/000076543
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Pediatric Hematology and Oncology
Inter- and intraindividual variability in ketamine dosage in repetitive invasive procedures in children with malignancies
Meyer, S; Aliani, S; Graf, N; Gottschling, S
Pediatric Hematology and Oncology, 21(2): 161-166.
10.1080/08880010490273082
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Pediatric Anesthesia
High dose dexmedetomidine as the sole sedative for pediatric MRI
Mason, KP; Zurakowski, D; Zgleszewski, SE; Robson, CD; Carrier, M; Hickey, PR; Dinardo, JA
Pediatric Anesthesia, 18(5): 403-411.
10.1111/j.1460-9592.2008.02468.x
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Annals of Emergency Medicine
Barriers to propofol use in emergency medicine
Green, SM; Krauss, B
Annals of Emergency Medicine, 52(4): 392-398.
10.1016/j.annemergmed.2007.12.002
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Pediatric Anesthesia
Midazolam as a sole sedative for computed tomography imaging in pediatric patients
Singh, R; Kumar, N; Vajifdar, H
Pediatric Anesthesia, 19(9): 899-904.
10.1111/j.1460-9592.2009.03084.x
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Wiener Klinische Wochenschrift
CO2 insufflation during colonoscopy decreases post-interventional pain in deeply sedated patients: a randomized controlled trial
Riss, S; Akan, B; Mikola, B; Rieder, E; Karner-Hanusch, J; Dirlea, D; Mittlbock, M; Weiser, FA
Wiener Klinische Wochenschrift, 121(): 464-468.
10.1007/s00508-009-1202-y
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Anesthesia and Analgesia
Level of Sedation with Nitrous Oxide for Pediatric Medical Procedures
Zier, JL; Tarrago, R; Liu, MX
Anesthesia and Analgesia, 110(5): 1399-1405.
10.1213/ANE.0b013e3181d539cf
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Hepatology
Nurse-Administered Propofol Sedation: Differences in Perspective
Dies, DF
Hepatology, 51(6): 2233.
10.1002/hep.23492
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Pediatric Anesthesia
Intravenous ketamine sedation for painful oncology procedures
Evans, D; Turnham, L; Barbour, K; Kobe, J; Wilson, L; Vandebeek, C; Montgomery, CJ; Rogers, P
Pediatric Anesthesia, 15(2): 131-138.
10.1111/j.1460-9592.2005.01407.x
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Endoscopy
Preparation, premedication, and surveillance
Lazzaroni, M; Porro, CB
Endoscopy, 37(2): 101-109.
10.1055/s-2004-826149
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International Journal of Pediatric Otorhinolaryngology
Nitrous oxide-oxygen inhalation for outpatient otologic examination and minor procedures performed on the uncooperative child
Fishman, G; Botzer, E; Marouani, N; DeRowe, A
International Journal of Pediatric Otorhinolaryngology, 69(4): 501-504.
10.1016/j.ijporl.2004.10.016
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Pediatric Anesthesia
Oral sedation with midazolam and diphenhydramine compared with midazolam alone in children undergoing magnetic resonance imaging
Cengiz, M; Baysal, Z; Ganidagli, S
Pediatric Anesthesia, 16(6): 621-626.
10.1111/j.1460-9592.2005.01820.x
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Pediatrics
Guidelines for monitoring and management of pediatric patients during and after sedation for diagnostic and therapeutic procedures: An update
Casamassimo, P; Cote, CJ; Crumrine, P; Gorman, RL; Hegenbarth, M; Wilson, S
Pediatrics, 118(6): 2587-2602.
10.1542/peds.2006-2780
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Clinical Gastroenterology and Hepatology
Bispectra index monitoring of conscious sedation with the combination of meperidine and midazolam during endoscopy
Qadeer, MA; Vargo, JJ; Patel, S; Dumot, JA; Lopez, AR; Trolli, PA; Conwell, DL; Stevens, T; Zuccaro, G
Clinical Gastroenterology and Hepatology, 6(1): 102-108.
10.1016/j.cgh.2007.10.005
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Pediatric Anesthesia
Electroencephalographic Narcotrend Index monitoring during procedural sedation and analgesia in children
Weber, F; Hollnberger, H; Weber, J
Pediatric Anesthesia, 18(9): 823-830.
10.1111/j.1460-9592.2008.02692.x
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Annals of Pharmacotherapy
Fospropofol: A New Sedative-Hypnotic Agent for Monitored Anesthesia Care
Moore, GD; Walker, AM; MacLaren, R
Annals of Pharmacotherapy, 43(): 1802-1808.
10.1345/aph.1M290
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Digestion
Level of Intended Sedation
Paspatis, GA; Tribonias, G; Paraskeva, K
Digestion, 82(2): 84-86.
10.1159/000285504
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Anasthesiologie & Intensivmedizin
Sedation for diagnostic and therapeutic measures in children
Philippi-Hohne, C; Becke, K; Wulff, B; Schmitz, B; Strauss, J; Reinhold, P
Anasthesiologie & Intensivmedizin, 51(): S603-S614.

Pediatrics
Comparison of propofol/fentanyl versus ketamine/midazolam for brief orthopedic procedural sedation in a pediatric emergency department
Godambe, SA; Elliot, V; Matheny, D; Pershad, J
Pediatrics, 112(1): 116-123.

Annals of Emergency Medicine
Clinical practice guideline for emergency department ketamine dissociative sedation in children
Green, SM; Krauss, B
Annals of Emergency Medicine, 44(5): 460-471.
10.1016/j.annermergmed.2004.06.006
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Pediatric Anesthesia
Pediatric sedation in North American children's hospitals: a survey of anesthesia providers
Lalwani, K; Michel, M
Pediatric Anesthesia, 15(3): 209-213.
10.1111/j.1460-9592.2005.01437.x
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Revista Espanola De Enfermedades Digestivas
Who should be responsible for sedation techniques in digestive endoscopy? Reply
Vilaplana, JC; Munoz, JED; Seara, JF; Seijo, AR
Revista Espanola De Enfermedades Digestivas, 97(6): 387-390.

Gastrointestinal Endoscopy
ERCP core curriculum
[Anon]
Gastrointestinal Endoscopy, 63(3): 361-376.
10.1016/j.gie.2006.01.010
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Journal of Urology
Nitrous oxide inhalation to improve patient acceptance and reduce procedure related pain of flexible cystoscopy for men younger than 55 years
Calleary, JG; Masood, J; Van-Mallaerts, R; Barua, JM
Journal of Urology, 178(1): 184-188.
10.1016/j.juro.2007.03.036
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British Journal of Anaesthesia
Behaviour of spectral entropy, spectral edge frequency 90%, and alpha and beta power parameters during low-dose propofol infusion
Mahon, P; Greene, BR; Greene, C; Boylan, GB; Shorten, GD
British Journal of Anaesthesia, 101(2): 213-221.
10.1093/bja/aen161
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American Journal of Gastroenterology
Nurse-administered propofol sedation for upper endoscopic ultrasonography
Fatima, H; DeWitt, J; LeBlanc, J; Sherman, S; McGreevy, K; Imperiale, TF
American Journal of Gastroenterology, 103(7): 1649-1656.
10.1111/j.1572-0241.2008.01906.x
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Archives of Pediatrics & Adolescent Medicine
Risks of Propofol Sedation/Anesthesia for Imaging Studies in Pediatric Research Eight Years of Experience in a Clinical Research Center
Kiringoda, R; Thurm, AE; Hirschtritt, ME; Koziol, D; Wesley, R; Swedo, SE; O'Grady, NP; Quezado, ZMN
Archives of Pediatrics & Adolescent Medicine, 164(6): 554-560.

Klinische Padiatrie
Gamma-hydroxybutyrate versus chlorprothixene/phenobarbital sedation in children undergoing MRI studies
Meyer, S; Gottschling, S; Georg, T; Lothschatz, D; Graf, N; Sitzmann, FC
Klinische Padiatrie, 215(2): 69-73.

Canadian Association of Radiologists Journal-Journal De L Association Canadienne Des Radiologistes
Canadian Radiology Residents' Knowledge of Sedation and Analgesia: A Web-Based Survey
Mayson, K; Lennox, P; Anserimo, M; Forster, BB
Canadian Association of Radiologists Journal-Journal De L Association Canadienne Des Radiologistes, 57(1): 35-42.

Pediatrics
Sleep deprivation for pediatric sedated procedures: Not worth the effort
Shields, CH; Johnson, S; Knoll, J; Chess, C; Goldberg, D; Creamer, K
Pediatrics, 113(5): 1204-1208.

Gastrointestinal Endoscopy
Training guideline for use of propofol in gastrointestinal endoscopy
Chutkan, R; Cohen, J; Abedi, M; Cruz-Correa, M; Dominitz, J; Gersin, K; Greenwald, D; Kantsevoy, S; Kowdley, K; Nguyen, M; Soetikno, R; Telford, J; Vargo, J
Gastrointestinal Endoscopy, 60(2): 167-172.

Pediatric Emergency Care
The effect of fasting practice on sedation with chloral hydrate
Keidan, I; Gozal, D; Minuskin, T; Weinberg, M; Barkaly, H; Augarten, A
Pediatric Emergency Care, 20(): 805-807.

Anasthesiologie & Intensivmedizin
Summary of the S3 guideline "Sedation during gastrointestinal endoscopy"
Assmann, A; Heinrichs, W; Landauer, B; Radke, J; Riphaus, A; Wehrmann, T; Van Aken, H; Martin, J
Anasthesiologie & Intensivmedizin, 50(): 176-+.

Digestive Diseases and Sciences
Risk Factors for Hypoxemia During Ambulatory Gastrointestinal Endoscopy in ASA I-II Patients
Qadeer, MA; Lopez, AR; Dumot, JA; Vargo, JJ
Digestive Diseases and Sciences, 54(5): 1035-1040.
10.1007/s10620-008-0452-2
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Journal of the Korean Medical Association
Monitored Anesthesia Care and Sedation/Analgesia Outside the Operating Room
Choi, YS
Journal of the Korean Medical Association, 52(6): 592-598.

Pediatric Anesthesia
Sedation trends in the 21st century: the transition to dexmedetomidine for radiological imaging studies
Mason, KP
Pediatric Anesthesia, 20(3): 265-272.
10.1111/j.1460-9592.2009.03224.x
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Gastroenterology
Non-Anesthesiologist Administered Propofol: Lessons Learned From Florida Reply
Rex, DK
Gastroenterology, 138(5): 2022-2024.
10.1053/j.gastro.2010.03.042
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Clinical Gastroenterology and Hepatology
Anesthesia-Mediated Sedation for Advanced Endoscopic Procedures and Cardiopulmonary Complications: Of Mountains and Molehills
Vargo, JJ
Clinical Gastroenterology and Hepatology, 8(2): 103-104.
10.1016/j.cgh.2009.11.001
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Gastrointestinal Endoscopy
Training in patient monitoring and sedation and analgesia
Vargo, JJ; Ahmad, AS; Aslanian, HR; Buscaglia, JM; Das, AM; Desilets, DJ; Dunkin, BJ; Inkster, M; Jamidar, PA; Kowalski, TE; Marks, JM; McHenry, L; Mishra, G; Petrini, JL; Pfau, PR; Savides, TA
Gastrointestinal Endoscopy, 66(1): 7-10.
10.1016/j.gie.2007.02.028
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Developmental Medicine and Child Neurology
Sedation with 50% nitrous oxide/oxygen for outpatient dental treatment in individuals with intellectual disability
Faulks, D; Hennequin, M; Albecker-Grappe, S; Maniere, MC; Tardieu, C; Berthet, A; Wolikow, M; Droz, D; Koscielny, S; Onody, P
Developmental Medicine and Child Neurology, 49(8): 621-625.

Gastrointestinal Endoscopy
Big NAPS, little NAPS, mixed NAPS, computerized NAPS: what is your flavor of propofol?
Vargo, JJ
Gastrointestinal Endoscopy, 66(3): 457-459.
10.1016/j.gie.2007.03.1035
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Journal of Clinical Anesthesia
The white elephant in the room
Weinstein, NJ; Gross, JB
Journal of Clinical Anesthesia, 19(5): 325-327.
10.1016/j.jclinane.2007.02.006
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Pediatric Anesthesia
Dose-response study of intrathecal fentanyl added to bupivacaine in infants undergoing lower abdominal and urologic surgery
Batra, YK; Lokesh, VC; Panda, NB; Rajeev, S; Rao, KLN
Pediatric Anesthesia, 18(7): 613-619.
10.1111/j.1460-9592.2008.02613.x
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Pediatrics
Supplemental oxygen compromises the use of pulse oximetry for detection of apnea and hypoventilation during sedation in simulated pediatric patients
Keidan, I; Gravenstein, D; Berkenstadt, H; Ziv, A; Shavit, I; Sidi, A
Pediatrics, 122(2): 293-298.
10.1542/peds.2007-2385
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Journal of Pediatrics
Widening sedation availability - Reply
Gozal, D; Gozal, Y
Journal of Pediatrics, 146(3): 439.
10.1016/j.jpeds.2004.09.017
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Monatsschrift Kinderheilkunde
Brief diagnostic procedures. Sedation and analgesia in children
Meyer, S; Kleinschmidt, S
Monatsschrift Kinderheilkunde, 153(3): 291-301.
10.1007/s00112-005-1097-2
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Pediatric Annals
Seclating patients for radiologic studies
Boswinkel, JP; Litman, RS
Pediatric Annals, 34(8): 650-+.

Annals of Saudi Medicine
Respiratory arrest after low-dose fentanyl
Topacoglu, H; Karcioglu, O; Cimrin, AH; Arnold, J
Annals of Saudi Medicine, 25(6): 508-510.

American Journal of Health-System Pharmacy
Clinical experience with patient-controlled analgesia using continuous respiratory monitoring and a smart infusion system
Maddox, RR; Williams, CK; Oglesby, H; Butler, B; Colclasure, B
American Journal of Health-System Pharmacy, 63(2): 157-164.
10.2146/ajhp050194
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Archives De Pediatrie
Sedation in children: how and for who?
Veyckemans, F
Archives De Pediatrie, 13(6): 835-837.
10.1016/j.arcped.2006.03.131
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European Journal of Pediatric Surgery
Conscious sedation: Off-label use of rectal S(+)-ketamine and midazolam for wound dressing changes in paediatric heat injuries
Heinrich, M; Wetzstein, V; Muensterer, OJ; Till, H
European Journal of Pediatric Surgery, 14(4): 235-239.
10.1055/s-2004-817960
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Gastrointestinal Endoscopy
Endoscopist administered propofol for upper-GI EUS is safe and effective: a prospective study in 500 patients
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Annals of Emergency Medicine
Preprocedural fasting and adverse events in procedural sedation and analgesia in a pediatric emergency department: Are they related?
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Heart
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Annals of Emergency Medicine
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American Journal of Roentgenology
Safety and Effectiveness of Analgesia with Remifentanil for Percutaneous Transhepatic Biliary Drainage
Park, NS; Bae, JI; Park, AW; Won, JH; Lee, HS
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Gastrointestinal Endoscopy
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Acta Anaesthesiologica Scandinavica
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Acta Anaesthesiologica Scandinavica, 47(8): 951-957.

Journal of Cardiothoracic and Vascular Anesthesia
Implantable cardioverter-defibrillator placement in patients with mild-to-moderate left ventricular dysfunction: Hemodynamics and recovery profile with two different anesthetics used during deep sedation
Camci, E; Koltka, K; Sungur, Z; Karadeniz, M; Yavru, A; Pembeci, K; Tugrul, M
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American Journal of Gastroenterology
Nurse-administered propofol Versus midazolam and meperidine for upper endoscopy in cirrhotic patients
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Pediatric Radiology
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Endoscopy
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Gastroenterology
AGA institute review of endoscopic sedation
Cohen, LB; Delegge, MH; Aisenberg, J; Brill, JV; Inadomi, JM; Kochman, ML; Piorkowski, JD
Gastroenterology, 133(2): 675-701.
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Journal of Clinical Anesthesia
Understanding modes of moderate sedation during gastrointestinal procedures: a current review of the literature
Lubarsky, DA; Candiotti, K; Harris, E
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British Journal of Anaesthesia
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Hohener, D; Blumenthal, S; Borgeat, A
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Chest
American College of Chest Physicians consensus statement on the respiratory and related management of patients with Duchenne muscular dystrophy undergoing anesthesia or sedation
Birnkrant, DJ; Panitch, HB; Benditt, JO; Boitano, LJ; Carter, ER; Cwik, VA; Finder, JD; Iannaccone, ST; Jacobson, LE; Kohn, GL; Motoyama, EK; Moxley, RT; Schroth, MK; Sharma, GD; Sussman, MD
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Pediatric Pulmonology
Sedation With Propofol for Flexible Bronchoscopy in Children
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Anesthesia and Analgesia
Capnography accurately detects apnea during monitored anesthesia care
Soto, RG; Fu, ES; Vila, H; Miguel, RV
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Annals of Emergency Medicine
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Academic Emergency Medicine
Procedural sedation in the community emergency department: Initial results of the ProSCED registry
Sacchetti, A; Senula, G; Strickland, J; Dubin, R
Academic Emergency Medicine, 14(1): 41-46.
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European Journal of Pediatrics
Sedation and analgesia for brief diagnostic and therapeutic procedures in children
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Annals of Emergency Medicine
A procedural sedation and analgesia fasting consensus advisory: One small step for emergency medicine, one giant challenge remaining
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Anesthesia and Analgesia
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Jama-Journal of the American Medical Association
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Vascular and Endovascular Surgery
A Prospective, Randomized, Placebo-Controlled Study Evaluating the Efficacy of Dexmedetomidine for Sedation During Vascular Procedures
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Journal of Vascular and Interventional Radiology
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American Journal of Gastroenterology
Propofol may be safely administered by trained nonanesthesiologists - CON: Propofol: Far from harmless
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Reviews in Cardiovascular Medicine
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Chirurg
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Zeitschrift Fur Gastroenterologie
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European Journal of Radiology
Conscious sedation for patients undergoing enteroclysis: Comparing the safety and patient-reported effectiveness of two protocols
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World Journal of Gastroenterology
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American Journal of Gastroenterology
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Journal of International Medical Research
Target-controlled propofol infusion for sedation in patients undergoing transrectal ultrasound-guided prostate biopsy
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American Journal of Surgery
Has the pendulum swung too far in postoperative pain control?
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International Journal of Oral & Maxillofacial Implants
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Clinical Pediatrics
Clinical utility of the bispectral index score when compared to the university of Michigan sedation scale in assessing the depth of outpatient pediatric sedation
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American Journal of Emergency Medicine
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American Journal of Gastroenterology
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Academic Emergency Medicine
Propofol for emergency department procedural sedation and analgesia: A tale of three centers
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Archives of Disease in Childhood-Education and Practice Edition
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British Journal of Anaesthesia
Propofol-based sedation regimen for infants and children undergoing ambulatory magnetic resonance imaging
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Gastrointestinal Endoscopy
Assessment of end-tidal carbon dioxide during pediatric and adult sedation for endoscopic procedures
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Annals of Emergency Medicine
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Deutsche Medizinische Wochenschrift
Successful risk management in flexible bronchoscopy
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American Journal of Gastroenterology
Where is the line between deep sedation and general anesthesia?
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Pediatric Anesthesia
Procedural sedation for insertion of central venous catheters in children: comparison of midazolam/fentanyl with midazolam/ketamine
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Annals of Emergency Medicine
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Anaesthesia
The accuracy of non-invasive carbon dioxide monitoring: A clinical evaluation of two transcutaneous systems
Bolliger, D; Steiner, LA; Kasper, J; Aziz, OA; Filipovic, M; Seeberger, MD
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Pediatric Anesthesia
Deep propofol sedation for vacuum-assisted bite-block immobilization in children undergoing proton radiation therapy of cranial tumors
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Surgical Endoscopy and Other Interventional Techniques
Single use of fentanyl in colonoscopy is safe and effective and significantly shortens recovery time
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Surgical Endoscopy and Other Interventional Techniques, 21(9): 1631-1636.
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Pediatric Anesthesia
Round and round we go: sedation - what is it, who does it, and have we made things safer for children?
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International Review of Psychiatry
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Southern Medical Journal
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American Journal of Gastroenterology
Endoscopic sedation in the United States: Results from a nationwide survey
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Pediatrics
A randomized comparison of nitrous oxide plus hematoma block versus ketamine plus midazolam for emergency department forearm fracture reduction in children
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Pediatric Anesthesia
Value of bispectral index monitor in differentiating between moderate and deep Ramsay Sedation Scores in children
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Respiratory Care
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Emergency Medicine Clinics of North America
Pulse Oximetry in Emergency Medicine
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Journal of Interventional Cardiac Electrophysiology
Predictors of hemodynamic compromise with propofol during defibrillator implantation: a single center experience
Pandya, K; Patel, MB; Natla, J; Dhoble, A; Habetler, T; Holliday, J; Janes, R; Punnam, SR; Gardiner, JC; Thakur, RK
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Clinical Radiology
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Clinical Radiology, 64(7): 655-663.
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Pediatric Anesthesia
Experience of intravenous sedation for pediatric gastrointestinal endoscopy in a large tertiary referral center in a developing country
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Endoscopy
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Canadian Association of Radiologists Journal-Journal De L Association Canadienne Des Radiologistes
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American Journal of Gastroenterology
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American Journal of Gastroenterology
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Emergency Medicine Australasia
Profiling adverse respiratory events and vomiting when using propofol for emergency department procedural sedation
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Journal of Oral and Maxillofacial Surgery
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Clinical Radiology
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Academic Emergency Medicine
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Pediatrics
EMLA cream and nitrous oxide to alleviate pain induced by palivizumab (Synagis) intramuscular injections in infants and young children
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Contraception
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Gastroenterology
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Gastroenterology
Position Statement: Nonanesthesiologist Administration of Propofol for GI Endoscopy
Vargo, JJ; Cohen, LB; Rex, DK; Kwo, PY
Gastroenterology, 137(6): 2161-2167.
10.1053/j.gastro.2009.09.050
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Pediatric Anesthesia
Leigh syndrome: Anesthetic management in complicated endoscopic procedures
Gozal, D; Goldin, E; Shafran-Tikva, S; Tal, D; Wengrower, D
Pediatric Anesthesia, 16(1): 38-42.
10.1111/j.1460-9592.2005.01678.x
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Gastrointestinal Endoscopy
Sedation and analgesia for GI endoscopy
Zuccaro, G
Gastrointestinal Endoscopy, 63(1): 95-96.
10.1016/j.gie.2005.10.007
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American Journal of Gastroenterology
Sedation for endoscopic procedures: Not as simple as it seems
Bailey, PL; Zuccaro, G
American Journal of Gastroenterology, 101(9): 2008-2010.
10.1111/j.1572-0241.2006.00807.x
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Pediatrics in Review
Conscious sedation: Reality or myth?
Koh, JL; Palermo, T
Pediatrics in Review, 28(7): 243-248.

Scandinavian Journal of Gastroenterology
Sedation with propofol for interventional endoscopic procedures: A risk factor analysis
Wehrmann, T; Riphaus, A
Scandinavian Journal of Gastroenterology, 43(3): 368-374.
10.1080/00365520701679181
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European Journal of Gastroenterology & Hepatology
Conscious sedation during endoscopic retrograde cholangiopancreatography: midazolam or midazolam plus meperidine?
Yuksel, O; Parlak, E; Koklu, S; Ertugrul, I; Tunc, B; Sahin, B
European Journal of Gastroenterology & Hepatology, 19(): 1002-1006.

Journal of Clinical Anesthesia
Safety evaluation of fospropofol for sedation during minor surgical procedures
Gan, TJ; Berry, BD; Ekman, EF; Muckerman, RC; Shore, N; Hardi, R
Journal of Clinical Anesthesia, 22(4): 260-267.
10.1016/j.jclinane.2009.08.007
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Revista De Investigacion Clinica
Efficacy of sedation in outpatient procedures performed by Pediatric residents
Morales-Sauceda, HN; de-la-O-Cavazos, ME; Gonzalez-Cordero, G; Elizondo-Omana, R; Guzman-Lopez, S; Torres-Vega, IA
Revista De Investigacion Clinica, 62(2): 109-114.

Endoscopy
Sympathovagal balance fluctuates during colonoscopy
Petelenz, M; Gonciarz, M; Macfarlane, P; Rudner, R; Kawecki, P; Musialik, J; Jalowiecki, P; Gonciarz, Z
Endoscopy, 36(6): 508-514.
10.1055/s-2004-814402
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Pediatric Transplantation
The use of multiple transbronchial biopsies as the standard approach to evaluate lung allograft rejection
Faro, A; Visner, G
Pediatric Transplantation, 8(4): 322-328.

Digestion
Combined pulse oximetry/cutaneous carbon dioxide tension monitoring during colonoscopies: Pilot study with a smart ear clip
Heuss, LT; Chhajed, PN; Schnieper, P; Hirt, T; Beglinger, C
Digestion, 70(3): 152-158.
10.1159/000081515
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Pediatric Blood & Cancer
Painful procedures in children with cancer: Comparison of moderate sedation and general anesthesia for lumbar puncture and bone marrow aspiration
Iannalfi, A; Bernini, C; Caprilli, S; Lippi, A; Tucci, F; Messeri, A
Pediatric Blood & Cancer, 45(7): 933-938.
10.1002/pbc.20567
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Klinische Padiatrie
Preparation and monitoring of sedation and analgosedation carried out by pediatricians and pediatric training assistants
Sauer, H; Haase, R; Lieser, U; Horneffl, G
Klinische Padiatrie, 220(3): 189-195.
10.1055/s-2008-1058109
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Emergency Medicine Clinics of North America
Capnography: A valuable Tool for Airway Management
Nagler, J; Krauss, B
Emergency Medicine Clinics of North America, 26(4): 881-+.
10.1016/j.emc.2008.08.005
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Emergency Medicine Journal
Is propofol a safe and effective sedative for relocating hip prostheses?
Mathieu, N; Jones, L; Harris, A; Hudson, A; McLauchlan, C; Riou, P; Lloyd, G
Emergency Medicine Journal, 26(1): 37-38.
10.1136/emj.2008.057729
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Anesthesia and Analgesia
The Incidence and Nature of Adverse Events During Pediatric Sedation/Anesthesia With Propofol for Procedures Outside the Operating Room: A Report From the Pediatric Sedation Research Consortium
Cravero, JP; Beach, ML; Blike, GT; Gallagher, SM; Hertzog, JH
Anesthesia and Analgesia, 108(3): 795-804.
10.1213/ane.0b013e31818fc334
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Scandinavian Journal of Gastroenterology
Propofol sedation for upper gastrointestinal endoscopy in patients with liver cirrhosis as an alternative to midazolam to avoid acute deterioration of minimal encephalopathy: A randomized, controlled study
Riphaus, A; Lechowicz, I; Frenz, MB; Wehrmann, T
Scandinavian Journal of Gastroenterology, 44(): 1244-1251.
10.1080/00365520903194591
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Drugs of Today
Fospropofol Disodium for Sedation
Campion, ME; Gan, TJ
Drugs of Today, 45(8): 567-576.

Annals of Emergency Medicine
A randomized, controlled trial of IV versus IM ketamine for sedation of pediatric patients receiving emergency department orthopedic procedures
Roback, MG; Wathen, JE; MacKenzie, T; Bajaj, L
Annals of Emergency Medicine, 48(5): 605-612.
10.1016/j.annemergmed.2006.06.001
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Journal of Emergency Medicine
The effect of the assignment of a pre-sedation target level on procedural sedation using propofol
Miner, JR; Huber, D; Nichols, S; Biros, M
Journal of Emergency Medicine, 32(3): 249-255.
10.1016/j.jemermed.2006.07.023
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Pediatric Anesthesia
Level of sedation evaluation with Cerebral State Index and A-Line Arx in children undergoing diagnostic procedures
Disma, N; Lauretta, D; Palermo, F; Sapienza, D; Ingelmo, PM; Astuto, M
Pediatric Anesthesia, 17(5): 445-451.
10.1111/j.1460-9592.2006.02146.x
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Annales Francaises D Anesthesie Et De Reanimation
Which anaesthesia for children undergoing MRI? An internet survey in the French university hospitals
Bordes, M; Semjen, F; Sautereau, A; Nossin, E; Benoit, I; Meymat, Y; Cros, AM
Annales Francaises D Anesthesie Et De Reanimation, 26(4): 287-291.
10.1016/j.annfar.2007.01.018
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American Journal of Emergency Medicine
The use of a pediatric emergency medicine-staffed sedation service during imaging: a retrospective analysis
Cutter, KO; Bush, AJ; Godambe, SA; Gilmore, B
American Journal of Emergency Medicine, 25(6): 654-661.
10.1016/j.ajem.2006.11.043
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Gastrointestinal Endoscopy
Lidocaine lollipop as single-agent anesthesia in upper GI endoscopy
Ayoub, C; Skoury, A; Abdul-Baki, H; Nasr, V; Soweid, A
Gastrointestinal Endoscopy, 66(4): 786-793.
10.1016/j.gie.2007.03.1086
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Heart
The safety and effectiveness of a nurse led cardioversion service under sedation
Boodhoo, L; Bordoli, G; Mitchell, AR; Lloyd, G; Sulke, N; Patel, N
Heart, 90(): 1443-1446.
10.1136/hrt.2004.034900
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Saudi Medical Journal
Target level controlled sedation. An alternative to general anesthesia in endovascular treatment of intracranial aneurysms
Senel, AC; Akyol, A; Uzunlar, H; Eroglu, A
Saudi Medical Journal, 26(): 1833-1835.

Anesthesia and Analgesia
Validation of the bispectral index monitor for measuring the depth of sedation in children
Sadhasivam, S; Ganesh, A; Robison, A; Kaye, R; Watcha, MF
Anesthesia and Analgesia, 102(2): 383-388.
10.1213/01.ANE.0000184115.57837.30
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Endoscopy
Current sedation and monitoring practice for colonoscopy: An international observational study (EPAGE)
Froehlich, F; Harris, JK; Wietlisbach, V; Burnand, B; Vader, JP; Gonvers, JJ
Endoscopy, 38(5): 461-469.
10.1055/s-2006-925368
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Pediatrics
Microstream capnography improves patient monitoring during moderate sedation: A randomized, controlled trial
Lightdale, JR; Goldmann, DA; Feldman, HA; Newburg, AR; DiNardo, JA; Fox, VL
Pediatrics, 117(6): E1170-E1178.
10.1542/peds.2005-1709
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Anesthesia and Analgesia
Dexmedetomidine for pediatric sedation for computed tomography imaging studies
Mason, KP; Zgleszewski, SE; Dearden, JL; Dumont, RS; Pirich, MA; Stark, CD; D'Angelo, P; MacPherson, S; Fontaine, PJ; Connor, L; Zurakowski, D
Anesthesia and Analgesia, 103(1): 57-62.
10.1213/01.ane.0000216293.16613.15
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Minerva Anestesiologica
Propofol sedation in a colorectal cancer screening outpatient cohort
Chelazzi, C; Consales, G; Boninsegni, P; Bonanomi, GA; Castiglione, G; De Gaudio, AR
Minerva Anestesiologica, 75(): 677-683.

British Journal of Anaesthesia
Caudal anaesthesia under sedation: a prospective analysis of 512 infants and children
Brenner, L; Kettner, SC; Marhofer, P; Latzke, D; Willschke, H; Kimberger, O; Adelmann, D; Machata, AM
British Journal of Anaesthesia, 104(6): 751-755.
10.1093/bja/aeq082
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Pediatric Anesthesia
Incidence and predictors of hypertension during high-dose dexmedetomidine sedation for pediatric MRI
Mason, KP; Zurakowski, D; Zgleszewski, S; Prescilla, R; Fontaine, PJ; Dinardo, JA
Pediatric Anesthesia, 20(6): 516-523.
10.1111/j.1460-9592.2010.03299.x
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Gastrointestinal Endoscopy
Moderate level sedation during endoscopy: a prospective study using low-dose propofol, meperldine/fentanyl, and midazolam
Cohen, LB; Hightower, CD; Wood, DA; Miller, KM; Aisenberg, J
Gastrointestinal Endoscopy, 59(7): 795-803.
PII S0016-5107(04)00349-9
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Pediatrics
Relief of pain and anxiety in pediatric patients in emergency medical systems
Zempsky, WT; Cravero, JP
Pediatrics, 114(5): 1348-1356.
10.1542/peds.2004-1752
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Pediatric Hematology and Oncology
Intraindividual propofol dosage variability in children undergoing repetitive procedural sedations
Gottschling, S; Meyer, S; Reinhard, H; Furtwangler, R; Klotz, D; Graf, N
Pediatric Hematology and Oncology, 23(7): 571-578.
10.1080/08880010600812595
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Annales Francaises D Anesthesie Et De Reanimation
Gastrointestinal endoscopy: which procedure, which operator?
Martin, C; Lienhart, A; Dureuil, B; Eledjam, JJ
Annales Francaises D Anesthesie Et De Reanimation, 25(9): 921-923.
10.1016/j.annfar.2006.07.076
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Pharmacological Reports
Safety of etomidate administration for procedural sedation in elderly emergency department patients
Sokolowski, J; Niewinska, K; Niewinski, P; Wiela-Hojenska, A; Jakubaszko, J
Pharmacological Reports, 59(): 249-253.

Periodontology 2000
Pain control and anxiety management for periodontal therapies
Wilson, KE; Dorman, ML; Moore, PA; Girdler, NM
Periodontology 2000, 46(): 42-55.

Journal of the American Association for Laboratory Animal Science
Baseline hemodynamics in anesthetized Landrace-Large White swine: Reference values for research in cardiac arrest and cardiopulmonary resuscitation models
Xanthos, T; Bassiakou, E; Koudouna, E; Tsirikos-Karapanos, N; Lelovas, P; Papadimitriou, D; Dontas, I; Papadimitriou, L
Journal of the American Association for Laboratory Animal Science, 46(5): 21-25.

American Journal of Gastroenterology
Position Statement: Nonanesthesiologist Administration of Propofol for GI Endoscopy
Vargo, JJ; Cohen, LB; Rex, DK; Kwo, PY
American Journal of Gastroenterology, 104(): 2886-2892.
10.1038/ajg.2009.607
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Hepatology
Position Statement: Nonanesthesiologist Administration of Propofol for GI Endoscopy
Vargo, JJ; Cohen, LB; Rex, DK; Kwo, PY
Hepatology, 50(6): 1683-1689.
10.1002/hep.23326
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Anesthesia and Analgesia
Monitored Anesthesia Care with Dexmedetomidine: A Prospective, Randomized, Double-Blind, Multicenter Trial
Candiotti, KA; Bergese, SD; Bokesch, PM; Feldman, MA; Wisemandle, W; Bekker, AY
Anesthesia and Analgesia, 110(1): 47-56.
10.1213/ane.0b013e3181ae0856
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Minerva Anestesiologica
Which type of sedation should be the target goal for use in colorectal endoscopic screening?
Runza, M
Minerva Anestesiologica, 75(): 673-674.

Archives of Pediatrics & Adolescent Medicine
Deep sedation with propofol by nonanesthesiologists - A prospective pediatric experience
Barbi, E; Gerarduzzi, T; Marchetti, F; Neri, E; Verucci, E; Bruno, I; Martelossi, S; Zanazzo, G; Sarti, A; Ventura, A
Archives of Pediatrics & Adolescent Medicine, 157(): 1097-1103.

Netherlands Journal of Medicine
Conscious sedation for endoscopic procedures
Scheffer, GJ
Netherlands Journal of Medicine, 62(1): 1-3.

Endoscopy
Deep sedation with propofol for upper gastrointestinal endoscopy in children, administered by specially trained pediatricians: a prospective case series with emphasis on side effects
Barbi, E; Petaros, P; Badina, L; Pahor, T; Giuseppin, I; Biasotto, E; Martelossi, S; Di Leo, G; Sarti, A; Ventura, A
Endoscopy, 38(4): 368-375.
10.1055/s-2005-921194
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Radiology
Is propofol a safe alternative to pentobarbital for sedation during pediatric diagnostic CT?
Zgleszewski, SE; Zurakowski, D; Fontaine, PJ; D'Angelo, M; Mason, KP
Radiology, 247(2): 528-534.
10.1148/radiol.2472062087
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Journal of Gastrointestinal and Liver Diseases
Propofol infusion versus intermittent meperidine and midazolam injection for conscious sedation in ERCP
Kongkam, P; Rerknimitr, R; Punyathavorn, S; Sitthi-Amorn, C; Ponauthai, Y; Prempracha, N; Kullavanijaya, P
Journal of Gastrointestinal and Liver Diseases, 17(3): 291-297.

Endoscopy
Satisfaction with bispectral index monitoring of propofol-mediated sedation during endoscopic submucosal dissection: a prospective, randomized study
Imagawa, A; Fujiki, S; Kawahara, Y; Matsushita, H; Ota, S; Tomoda, T; Morito, Y; Sakakihara, I; Fujimoto, T; Taira, A; Tsugeno, H; Kawano, S; Yagi, S; Takenaka, R
Endoscopy, 40(): 905-909.
10.1055/s-2008-1077641
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Drugs
Analgo-Sedation of Patients with Burns Outside the Operating Room
Gregoretti, C; Decaroli, D; Piacevoli, Q; Mistretta, A; Barzaghi, N; Luxardo, N; Tosetti, I; Tedeschi, L; Burbi, L; Navalesi, P; Azzeri, F
Drugs, 68(): 2427-2443.

American Journal of Roentgenology
Radiologist-Supervised Ketamine Sedation for Solid Organ Biopsies in Children and Adolescents
Mason, KP; Padua, H; Fontaine, PJ; Zurakowski, D
American Journal of Roentgenology, 192(5): 1261-1265.
10.2214/AJR.08.1743
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Gastrointestinal Endoscopy
Procedural sedation and obesity: waters left uncharted
Vargo, JJ
Gastrointestinal Endoscopy, 70(5): 980-984.
10.1016/j.gie.2009.07.003
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Journal of the American Dental Association
Balancing efficacy and safety in the use of oral sedation in dental outpatients
Dionne, RA; Yagiela, JA; Cote, CJ; Donaldson, M; Edwards, M; Greenblatt, DJ; Haas, D; Malviya, S; Milgrom, P; Moore, PA; Shampaine, G; Silverman, M; Williams, RL; Wilson, S
Journal of the American Dental Association, 137(4): 502-513.

Alimentary Pharmacology & Therapeutics
Review article: moderate sedation for endoscopy: sedation regimens for non-anaesthesiologists
Rex, DK
Alimentary Pharmacology & Therapeutics, 24(2): 163-171.
10.1111/j.1365-2036.2006.02986.x
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Revista Espanola De Enfermedades Digestivas
Endoscopist controlled administration of propofol: an effective and safe method of sedation in endoscopic procedures
Saenz-Lopez, S; Munoz, SR; Rodriguez-Alcalde, D; Franco, A; Marin, JC; de la Cruz, J; Herruzo, JAS
Revista Espanola De Enfermedades Digestivas, 98(1): 25-35.

Emergency Medicine Journal
Propofol for procedural sedation in the emergency department
Dunn, T; Mossop, D; Newton, A; Gammon, A
Emergency Medicine Journal, 24(7): 459-461.
10.1136/emj.2007.046714
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Pediatric Dentistry
Pediatric Dentistry - Reference manual
[Anon]
Pediatric Dentistry, 29(7): 1-271.

Digestive Endoscopy
Risk management for sedation in endoscopic submucosal dissection
Naruse, M; Inatsuchifi, S
Digestive Endoscopy, 19(): S2-S4.
10.1111/j.1443-1661.2007.00718.x
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Pediatric Anesthesia
Sevoflurane sedation in infants undergoing MRI: a preliminary report
Sury, MRJ; Harker, H; Thomas, ML
Pediatric Anesthesia, 15(1): 16-22.
10.1111/j.1460-9592.2005.01456.x
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Gastrointestinal Endoscopy
From oral midazolam to propofol: a perspective
Geller, E
Gastrointestinal Endoscopy, 61(2): 201-203.

Gastroenterology
Trained registered nurses/endoscopy teams can administer propofol safely for endoscopy
Rex, DK; Heuss, LT; Walker, JA; Qi, R
Gastroenterology, 129(5): 1384-1391.
10.1053/j.gastro.2005.08.014
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Journal of Vascular and Interventional Radiology
Pain and anxiety: Two problems, two solutions
Martin, ML; Lennox, PH; Buckley, BT
Journal of Vascular and Interventional Radiology, 16(): 1581-1584.
10.1097/01.RVI.0000167588.84460.FD
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Journal of Cardiothoracic and Vascular Anesthesia
Con: Moderate sedation is safely performed by nonanesthesiologists during percutaneous vascular interventions
Wittgen, CM
Journal of Cardiothoracic and Vascular Anesthesia, 19(6): 805-808.
10.1053/j.jvca.2005.08.016
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Gastrointestinal Endoscopy
Quality indicators for gastrointestinal endoscopic procedures: an introduction
Faigel, DO; Pike, IM; Baron, TH; Chak, A; Cohen, J; Deal, SE; Hoffman, B; Jacobson, BC; Mergener, K; Petersen, BT; Petrini, JL; Rex, DK; Safdi, MA
Gastrointestinal Endoscopy, 63(4): S3-S9.
10.1016/j.gie.2006.02.017
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Clinica Terapeutica
Sedation with Propofol for endoscopic retrograde cholangiopancreatography: personal experience
Zippi, M; Traversa, G; De Felici, I; Febbraro, I; Mattei, E; Pietranico, B; Sergio, C; Sgarro, MG; Occhigrosssi, G
Clinica Terapeutica, 159(1): 19-22.

Minerva Anestesiologica
Transcutaneous carbon dioxide monitoring in spontaneously breathing, nonintubated patients in the early postoperative period
Fanelli, G; Baciarello, M; Squicciarini, G; Malagutti, G; Zasa, M; Casati, A
Minerva Anestesiologica, 74(): 375-380.

Acta Oto-Laryngologica
Retroauricular tympanoplasty and tympanomastoidectomy under local anesthesia and sedation
Sarmento, KMD; Tomita, S
Acta Oto-Laryngologica, 129(7): 726-728.
10.1080/00016480802398996
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Digestion
Sedation Training Using a Human Patient Simulator
Hofmann, N; Datz, C; Schochl, H
Digestion, 82(2): 115-117.
10.1159/000287214
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Gastrointestinal Endoscopy
Guidelines for conscious sedation and monitoring during gastrointestinal endoscopy
Waring, JP; Baron, TH; Hirota, WK; Goldstein, JL; Jacobson, BC; Leighton, JA; Mallery, JS; Faigel, DO
Gastrointestinal Endoscopy, 58(3): 317-322.

Pediatric Anesthesia
Sevoflurane sedation in infants - a fine line between sedation and general anesthesia
Ng, A
Pediatric Anesthesia, 15(1): 1-2.
10.1111/j.1460-9592.2005.01508.x
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Journal of Pediatric Surgery
Clinical policy: Evidence-based approach to pharmacologic agents used in pediatric sedation and analgesia in the emergency department
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Anesthesia and Analgesia
Sedation and anesthesia protocols used for magnetic resonance imaging studies in infants: provider and pharmacologic considerations
Dalal, PG; Murray, D; Cox, T; McAllister, J; Snider, R
Anesthesia and Analgesia, 103(4): 863-868.
10.1213/01.ane.0000237311.15294.0e
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Samj South African Medical Journal
Conscious sedation v. monitored anaesthesia care - 20 years in the South African context
Stefanutto, T; Ruttmann, T
Samj South African Medical Journal, 96(): 1252-1254.

Expert Opinion on Drug Safety
A review of the safety of 50% nitrous oxide/oxygen in conscious sedation
Collado, V; Nicolas, E; Faulks, D; Hennequin, M
Expert Opinion on Drug Safety, 6(5): 559-571.
10.1517/14740338.6.5.559
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Pediatrics
Propofol sedation: Intensivists' experience with 7304 cases in a Children's Hospital
Vespasiano, M; Finkelstein, M; Kurachek, S
Pediatrics, 120(6): E1411-E1417.
10.1542/peds.2007-0145
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Academic Emergency Medicine
The National Emergency Department Safety Study: Study rationale and design
Sullivan, AF; Camargo, CA; Cleary, PD; Gordon, JA; Guadagnoli, E; Kaushal, R; Magid, DJ; Rao, SR; Blumenthal, D
Academic Emergency Medicine, 14(): 1182-1189.
10.1197/j.aem.2007.07.014
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Annals of Emergency Medicine
Clinical policy: Critical issues in the sedation of pediatric patients in the emergency department
Mace, SE; Brown, LA; Francis, L; Godwin, SA; Hahn, SA; Howard, PK; Kennedy, RM; Mooney, DP; Sacchetti, AD; Wears, RL; Clark, RM
Annals of Emergency Medicine, 51(4): 378-399.
10.1016/j.annemergmed.2007.11.001
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Journal of Clinical Nursing
Comparison of the effect of protocol-directed sedation with propofol vs. midazolam by nurses in intensive care: efficacy, haemodynamic stability and patient satisfaction
Liou, HL; Shih, CC; Tang, JJ; Lai, ST; Chen, HI
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Best Practice & Research in Clinical Gastroenterology
Sedation in endoscopy: When and how
Regula, J; Sokol-Kobielska, E
Best Practice & Research in Clinical Gastroenterology, 22(5): 945-957.
10.1016/j.bpg.2008.06.002
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Anasthesiologie & Intensivmedizin
Comments to the use of laughing gas(Nitrous oxide)in sedation of children during dental interventions
Hohne, C; Reinhold, P
Anasthesiologie & Intensivmedizin, 49(): 534-535.

Gastrointestinal Endoscopy
Propofol for endoscopic sedation: a protocol for safe and effective administration by the gastroenterologist
Cohen, LB; Dubovsky, AN; Aisenberg, J; Miller, KM
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Annals of Emergency Medicine
Propofol in emergency medicine: Pushing the sedation frontier
Green, SM; Krauss, B
Annals of Emergency Medicine, 42(6): 792-797.
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Gastrointestinal Endoscopy
Safety of intravenous midazolam and fentanyl for pediatric GI endoscopy: prospective study of 1578 endoscopies
Mamula, P; Markowitz, JE; Neiswender, K; Zimmerman, A; Wood, S; Garofolo, M; Nieberle, M; Trautwein, A; Lombardi, S; Sargent-Harkins, L; Lachewitz, G; Farace, L; Morgan, V; Puma, A; Cook-Sather, SD; Liacouras, CA
Gastrointestinal Endoscopy, 65(2): 203-210.
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American Journal of Gastroenterology
Endoscopist administered sedation during ERCP: Impact of chronic narcotic/benzodiazepine use and predictive risk of reversal agent utilization
Papachristou, GI; Gleeson, FC; Papachristou, DJ; Petersen, BT; Baron, TH
American Journal of Gastroenterology, 102(4): 738-743.
10.1111/j.1572-0241.2007.01093.x
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European Journal of Cardiovascular Nursing
Risk factors for impaired respiratory function during nurse-administered procedural sedation and analgesia in the cardiac catheterisation laboratory: a matched case-control study
Conway, A; Page, K; Rolley, J; Fulbrook, P
European Journal of Cardiovascular Nursing, 12(4): 393-399.
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Seminars in Roentgenology
Sedation and anesthesia for interventional oncology
Neilson, GA; Lennox, PH
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Pediatric Anesthesia
Training and credentialing in procedural sedation and analgesia in children: lessons from the United States model
Krauss, B; Green, SM
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Journal of Cardiovascular Electrophysiology
Pain and anatomical locations of radiofrequency ablation as predictors of esophageal temperature rise during pulmonary vein isolation
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Journal of Interventional Cardiac Electrophysiology
Intravenous sedation for cardiac procedures can be administered safely and cost-effectively by non-anesthesia personnel
Kezerashvili, A; Fisher, JD; DeLaney, J; Mushiyev, S; Monahan, E; Taylor, V; Kim, SG; Ferrick, KJ; Gross, JN; Palma, EC; Krumerman, AK
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Archives De Pediatrie
Analgesia in the pediatric emergency department
Cheron, G; Cojocaru, B; Bocquet, N
Archives De Pediatrie, 11(1): 70-73.
10.1016/S0929-693X(03)00490-1
CrossRef
American Journal of Gastroenterology
The science and politics of propofol
Rex, DK
American Journal of Gastroenterology, 99(): 2080-2083.
10.1111/j.1572-0241.41325.x
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American Journal of Emergency Medicine
Pulse oximetry in the detection of hypercapnia
Stemp, LI; Ramsay, MA
American Journal of Emergency Medicine, 24(1): 136-137.
10.1016/j.ajem.2005.08.010
CrossRef
Academic Emergency Medicine
Does end-tidal carbon dioxide monitoring detect respiratory events prior to current sedation monitoring practices?
Burton, JH; Harrah, JD; Germann, CA; Dillon, DC
Academic Emergency Medicine, 13(5): 500-504.
10.1197/j.aem.2005.12.017
CrossRef
American Journal of Gastroenterology
Efficacy of bispectral monitoring as an adjunct to nurse-administered propofol sedation for colonoscopy: A randomized controlled trial
Drake, LM; Chen, SC; Rex, DK
American Journal of Gastroenterology, 101(9): 2003-2007.
10.1111/j.1572-0241.2006.00806.x
CrossRef
Pediatrics
Incidence and nature of adverse events during pediatric sedation/anesthesia for procedures outside the operating room: Report from the pediatric sedation research consortium
Cravero, JP; Blike, GT; Beach, M; Gallagher, SM; Hertzog, JH; Havidich, JE; Gelman, B
Pediatrics, 118(3): 1087-1096.
10.1542/peds.2006-0313
CrossRef
Pediatrics
Guidelines for monitoring and management of pediatric patients during and after sedation for diagnostic and therapeutic procedures: Addendum
Gorman, R; Bates, BA; Benitz, WE; Burchfield, DJ; Ring, JC; Walls, RP; Walson, PD; Alexander, J; Bennett, DR; Hagino, OR; Matsui, D; Riley, LE; Giacoia, GP; Cote, CJ; Koteras, RJ
Pediatrics, 110(4): 836-838.

Journal of Urology
Re: Nitrous oxide (Entonox) inhalation and tolerance of transrectal ultrasound guided prostate biopsy: A double-blind randomized controlled study
Jones, JS
Journal of Urology, 169(5): 1799-1800.
10.1097/01.ju.0000057805.61396.b0
CrossRef
Alimentary Pharmacology & Therapeutics
Review article: registered nurse-administered propofol sedation for endoscopy
Chen, SC; Rex, DK
Alimentary Pharmacology & Therapeutics, 19(2): 147-155.
10.1111/j.0269-2813.2004.01833.x
CrossRef
Radiographics
Sedation, Analgesia, and Local Anesthesia: A Review for General and Interventional Radiologists
Moran, TC; Kaye, AD; Mai, AH; Bok, LR
Radiographics, 33(2): E47-E60.
10.1148/rg.332125012
CrossRef
Journal of Anesthesia
Analysis of expert consultation referrals to the Korean Society of Anesthesiologists (KSA): a comparison of procedural sedation and general anesthesia
Hong, SJ; Kang, YJ; Jeon, YH; Son, JS; Song, JH; Yoo, CS; Kim, DK
Journal of Anesthesia, 27(2): 218-223.
10.1007/s00540-012-1497-0
CrossRef
Radiology
Dexmedetomidine Offers an Option for Safe and Effective Sedation for Nuclear Medicine Imaging in Children
Mason, KP; Robinson, F; Fontaine, P; Prescilla, R
Radiology, 267(3): 911-917.
10.1148/radiol.13121232
CrossRef
Journal of the Korean Medical Association
Procedural sedation and analgesia in children
Song, JH
Journal of the Korean Medical Association, 56(4): 271-278.
10.5124/jkma.2010.56.4.271
CrossRef
Journal of the Korean Medical Association
Pharmacokinetics and pharmacodynamics of drugs for sedation
Lee, YS
Journal of the Korean Medical Association, 56(4): 279-284.
10.5124/jkma.2013.56.4.279
CrossRef
Journal of the Korean Medical Association
Issues in procedural sedation outside the operating theater: characteristics and safety of commonly used sedatives and analgesics
Yoo, YC
Journal of the Korean Medical Association, 56(4): 285-291.
10.5124/jkma.2010.56.4.285
CrossRef
Digestive Endoscopy
Administration of additional analgesics can decrease the incidence of paradoxical reactions in patients under benzodiazepine-induced sedation during endoscopic transpapillary procedures: Prospective randomized controlled trial
Terui, T; Inomata, M
Digestive Endoscopy, 25(1): 53-59.
10.1111/j.1443-1661.2012.01325.x
CrossRef
Zeitschrift Fur Gastroenterologie
Impact of S3 Training Courses "Sedation and Emergency Management in Endoscopy for Endoscopy Nurses and Assisting Personnel" on the Process and Structure Quality in Gastroenterological Endoscopy in Practices and Clinics - Results of a Nationwide Survey
Schilling, D; Leicht, K; Beilenhoff, U; Waechter, EK; Kallinowski, B; Labenz, J; Weiss, C; Buttner, S; Riphaus, A
Zeitschrift Fur Gastroenterologie, 51(7): 619-627.
10.1055/s-0032-1330677
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Gastroenterology Research and Practice
Glossopharyngeal Nerve Block versus Lidocaine Spray to Improve Tolerance in Upper Gastrointestinal Endoscopy
Ramirez, MO; Segovia, BL; Cuevas, MAG; Romero, JLS; Buenrostro, IB; Licona, NA; Mendoza, JMG; Romero, JFG; Zarate, VMV
Gastroenterology Research and Practice, (): -.
ARTN 264509
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Journal of Burn Care & Research
Ketamine: A Safe and Effective Agent for Painful Procedures in the Pediatric Burn Patient
Owens, VF; Palmieri, TL; Comroe, CM; Conroy, JM; Scavone, JA; Greenhalgh, DG
Journal of Burn Care & Research, 27(2): 211-216.
10.1097/01.BCR.0000204310.67594.A1
PDF (565) | CrossRef
Journal of Burn Care & Research
Invited Critique
Jellish, WS
Journal of Burn Care & Research, 27(2): 217.
10.1097/01.bcr.0000214843.17664.4b
PDF (36) | CrossRef
Critical Care Medicine
General anesthesia in the intensive care unit? Is it ready for “prime time”?*
Maccioli, GA; Cohen, NH
Critical Care Medicine, 33(3): 687-688.
10.1097/01.CCM.0000155914.81377.B5
PDF (1156) | CrossRef
Current Opinion in Anesthesiology
Anaesthesia outside the operating room: conflicting strategies?
Bonnet, F; Marret, E
Current Opinion in Anesthesiology, 21(4): 478-479.
10.1097/ACO.0b013e328306a94b
PDF (43) | CrossRef
Current Opinion in Anesthesiology
Anesthesia or sedation for gastroenterologic endoscopies
Luginbühl, M; Vuilleumier, P; Schumacher, P; Stüber, F
Current Opinion in Anesthesiology, 22(4): 524-531.
10.1097/ACO.0b013e32832dbb7c
PDF (357) | CrossRef
European Journal of Anaesthesiology (EJA)
Performance of AEP Monitor/2‐derived composite index as an indicator for depth of sedation with midazolam and alfentanil during gastrointestinal endoscopy
Huang, Y; Chu, Y; Chang, K; Wang, Y; Chan, K; Tsou, M
European Journal of Anaesthesiology (EJA), 24(3): 252&hyhen;257.
10.1017/S0265021506001633
PDF (120) | CrossRef
European Journal of Anaesthesiology (EJA)
The Helsinki Declaration on Patient Safety in Anaesthesiology
Mellin-Olsen, J; Staender, S; Whitaker, DK; Smith, AF
European Journal of Anaesthesiology (EJA), 27(7): 592-597.
10.1097/EJA.0b013e32833b1adf
PDF (121) | CrossRef
Gastroenterology Nursing
Nurse‐Administered Propofol Sedation: A Review of Current Evidence
Harrington, L
Gastroenterology Nursing, 29(5): 371-383.

PDF (330)
Journal of Neurosurgical Anesthesiology
Anesthesia for Minimally Invasive Cranial and Spinal Surgery
Schubert, A; Deogaonkar, A; Lotto, M; Niezgoda, J; Luciano, M
Journal of Neurosurgical Anesthesiology, 18(1): 47-56.

PDF (625)
Journal of Pediatric Gastroenterology and Nutrition
Sedation and Anesthesia in Pediatric Endoscopy: One Size Does Not Fit All
Schwarz, SM; Lightdale, JR; Liacouras, CA
Journal of Pediatric Gastroenterology and Nutrition, 44(3): 295-297.
10.1097/MPG.0b013e31802f6435
PDF (97) | CrossRef
Journal of Pediatric Hematology/Oncology
Propofol Versus Midazolam/Ketamine for Procedural Sedation in Pediatric Oncology
Graf, N; Gottschling, S; Meyer, S; Krenn, T; Reinhard, H; Lothschuetz, D; Nunold, H
Journal of Pediatric Hematology/Oncology, 27(9): 471-476.

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Plastic and Reconstructive Surgery
A Role for the Anesthesiologist in Elective Cosmetic Surgery?
Friedberg, BL
Plastic and Reconstructive Surgery, 111(2): 953-955.

PDF (2388)
Plastic and Reconstructive Surgery
Evidence-Based Patient Safety Advisory: Patient Selection and Procedures in Ambulatory Surgery
Haeck, PC; Swanson, JA; Iverson, RE; Schechter, LS; Singer, R; Basu, CB; Damitz, LA; Glasberg, SB; Glassman, LS; McGuire, MF; the ASPS Patient Safety Committee,
Plastic and Reconstructive Surgery, 124(4S): 6S-27S.
10.1097/PRS.0b013e3181b8e880
PDF (1067) | CrossRef
AJN The American Journal of Nursing
Pulse Oximetry in Adults
Valdez-Lowe, C; Ghareeb, SA; Artinian, NT
AJN The American Journal of Nursing, 109(6): 52-59.
10.1097/01.NAJ.0000352474.55746.81
PDF (1236) | CrossRef
Anesthesiology
New Insights about an Old Foe
Nunnally, ME; Apfelbaum, JL
Anesthesiology, 112(1): 10-11.
10.1097/01.anes.0000365962.59021.02
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Anesthesiology
The American Society of Anesthesiologist's Efforts in Developing Guidelines for Sedation and Analgesia for Nonanesthesiologists: The 40th Rovenstine Lecture
Epstein, BS
Anesthesiology, 98(5): 1261-1268.

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Clinical Obstetrics and Gynecology
Analgesia/Pain Management in First Trimester Surgical Abortion
MECKSTROTH, KR; MISHRA, K
Clinical Obstetrics and Gynecology, 52(2): 160-170.
10.1097/GRF.0b013e3181a2b0e8
PDF (120) | CrossRef
Current Opinion in Anesthesiology
Pediatric sedation/anesthesia outside the operating room
Gozal, D; Gozal, Y
Current Opinion in Anesthesiology, 21(4): 494-498.
10.1097/ACO.0b013e3283079b6c
PDF (101) | CrossRef
Current Opinion in Pediatrics
Sedation for emergent diagnostic imaging studies in pediatric patients
Rutman, MS
Current Opinion in Pediatrics, 21(3): 306-312.
10.1097/MOP.0b013e32832b10f6
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European Journal of Gastroenterology & Hepatology
Use of sedation in gastrointestinal endoscopy: a nationwide survey in Spain
Baudet, J; Borque, P; Borja, E; Alarcón-Fernández, O; Sánchez-del-Río, A; Campo, R; Avilés, J
European Journal of Gastroenterology & Hepatology, 21(8): 882-888.
10.1097/MEG.0b013e328314b7ca
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Journal of Computer Assisted Tomography
Increased Risk of General Anesthesia for High-Risk Patients Undergoing Magnetic Resonance Imaging
Girshin, M; Shapiro, V; Rhee, A; Ginsberg, S; Inchiosa, MA
Journal of Computer Assisted Tomography, 33(2): 312-315.
10.1097/RCT.0b013e31818474b8
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Pediatric Emergency Care
Pain and Sedationm
Poirier, MP; Isaacman, DJ; Strait, RT; Counselman, FL; Foster, RL
Pediatric Emergency Care, 20(1): 57-62.

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Pediatric Emergency Care
Pediatric Procedural Sedation in the Community Emergency Department: Results From the ProSCED Registry
Sacchetti, A; Stander, E; Ferguson, N; Maniar, G; Valko, P
Pediatric Emergency Care, 23(4): 218-222.
10.1097/PEC.0b013e31803e176c
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Pediatric Emergency Care
Guidelines to Practice: The Process of Planning and Implementing a Pediatric Sedation Program
Ratnapalan, S; Schneeweiss, S
Pediatric Emergency Care, 23(4): 262-266.
10.1097/PEC.0b013e31803f7566
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Pediatric Emergency Care
Atomized Intranasal Midazolam Use for Minor Procedures in the Pediatric Emergency Department
Lane, RD; Schunk, JE
Pediatric Emergency Care, 24(5): 300-303.
10.1097/PEC.0b013e31816ecb6f
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Plastic and Reconstructive Surgery
A Role for the Anesthesiologist in Elective Cosmetic Surgery
Friedberg, BL
Plastic and Reconstructive Surgery, 111(3): 1365-1366.

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Plastic and Reconstructive Surgery
Nitrous Oxide Administered by the Plastic Surgeon for Repair of Facial Lacerations in Children in the Emergency Room
Bar-Meir, E; Zaslansky, R; Regev, E; Keidan, I; Orenstein, A; Winkler, E
Plastic and Reconstructive Surgery, 117(5): 1571-1575.
10.1097/01.prs.0000206298.71083.df
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Plastic and Reconstructive Surgery
The Impact of Topical Lidocaine on Pain Level Assessment during and after Vacuum-Assisted Closure Dressing Changes: A Double-Blind, Prospective, Randomized Study
Franczyk, M; Lohman, RF; Agarwal, JP; Rupani, G; Drum, M; Gottlieb, LJ
Plastic and Reconstructive Surgery, 124(3): 854-861.
10.1097/PRS.0b013e3181b038b4
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