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Airway rescue during sedation

a proposed airway rescue pathway for nonanesthesiologists

Thackeray, Elizabeth M.; Johnson, Ken B.

Current Opinion in Anesthesiology: August 2019 - Volume 32 - Issue 4 - p 464–471
doi: 10.1097/ACO.0000000000000760
DRUGS IN ANESTHESIA: Edited by Ken B. Johnson

Purpose of review This review summarizes key features of adverse airway and respiratory events for which sedation providers must be prepared to diagnose and treat in a timely manner. Key features include elements of the presedation patient evaluation that predict adverse airway and respiratory events; patient profiles, target sedation levels, and procedure types that should prompt a consult with an anesthesiologist; necessary clinical skills, essential equipment, and reversal drugs necessary to manage adverse airway and respiratory events; and a proposed airway rescue pathway that describes a sequence of interventions and prompts to call for help when encountering an adverse airway or respiratory event.

Recent findings Several studies have reported adverse events from sedation. Although the overall rate can approach 4.5%, the incidence of events associated with severe harm is low (e.g., <0.5%). Some that are most harmful are prolonged ventilatory compromise leading to hypoxic brain injury or death. Inadequate clinical skills that contribute to these poor outcomes include undetected or delayed detection of hypopnea, apnea, and partial or complete airway obstruction, inadequate rescue skills to manage drug-induced ventilatory depression or airway obstruction, and/or a delay or no attempt to call for expert help followed by a timely response and intervention from that expert help.

Summary To improve outcomes in detecting and managing adverse airway and respiratory events, nonanesthesiologists sedation practitioners must be trained in patient selection, monitoring, pharmacology, physiology, and airway management. One gap in sedation training curriculum is a roadmap to use when managing an adverse airway or respiratory events. This review puts forth a suggested airway rescue pathway for nonanesthesiologist sedation practitioners to use as a decision aid during an adverse airway or respiratory event associated with procedural sedation.

Department of Anesthesiology, University of Utah, Salt Lake City, Utah, USA

Correspondence to Elizabeth M. Thackeray, MD, MPH, Department of Anesthesiology, University of Utah, 30 North 1900 East, Room 3C444, Salt Lake City, UT 84132, USA. Tel: +1 801 581 6393; e-mail:

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