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Moderate and deep sedation training and pharmacology for nonanesthesiologists

recommendations for effective practice

Tran, Thi T.a; Beutler, Sascha S.a; Urman, Richard D.a,b

Current Opinion in Anesthesiology: August 2019 - Volume 32 - Issue 4 - p 457–463
doi: 10.1097/ACO.0000000000000758
DRUGS IN ANESTHESIA: Edited by Ken B. Johnson

Purpose of review The purpose of this review is to discuss current drugs used for intravenous moderate and deep sedation by nonanesthesiologists in the United States. We also explore training expectations for moderate and deep sedation as they play key roles in anesthetic selection and preprocedural planning.

Recent findings Although opioids and benzodiazepines are considered the standard for moderate sedation, increased interest in propofol, dexmedetomidine, and other sedative-hyptonic drugs require additional attention in terms of training providers and complying with current practice guidelines.

Summary Moderate sedation providers should be familiar with titrating benzodiazepines and opioids to achieve targeted sedation. The use of propofol and ketamine is generally reserved for deep sedation by qualified professionals. However, the role of dexmedetomidine in procedural sedation continues to evolve as its use is explored in moderate sedation. Providers of all sedation types should be aware of hypotension, apnea, hypoventilation, and hypoxia that can develop and they should be able to manage the patient under these circumstances. Preprocedural planning is an integral training expectation to minimize patient risks.

aDepartment of Anesthesiology, Perioperative and Pain Medicine

bCenter for Perioperative Research, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA

Correspondence to Richard D. Urman, MD, MBA, Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, 75 Francis Street – CWN L1, Boston, MA 02115, USA. Tel: +1 617 732 8222; e-mail:

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