Procedural sedation and analgesia (PSA) has become a widespread practice given the increasing demand to relieve anxiety, discomfort and pain during invasive diagnostic and therapeutic procedures. The role of, and credentialing required by, anaesthesiologists and practitioners performing PSA has been debated for years in different guidelines. For this reason, the European Society of Anaesthesiology (ESA) and the European Board of Anaesthesiology have created a taskforce of experts that has been assigned to create an evidence-based guideline and, whenever the evidence was weak, a consensus amongst experts on: the evaluation of adult patients undergoing PSA, the role and competences required for the clinicians to safely perform PSA, the commonly used drugs for PSA, the adverse events that PSA can lead to, the minimum monitoring requirements and post-procedure discharge criteria. A search of the literature from 2003 to 2016 was performed by a professional librarian and the retrieved articles were analysed to allow a critical appraisal according to the Grading of Recommendations Assessment, Development and Evaluation method. The Taskforce selected 2248 articles. Where there was insufficiently clear and concordant evidence on a topic, the Rand Appropriateness Method with three rounds of Delphi voting was used to obtain the highest level of consensus among the taskforce experts.
These guidelines contain recommendations on PSA in the adult population. It does not address sedation performed in the ICU or in children and it does not aim to provide a legal statement on how PSA should be performed and by whom. The National Societies of Anaesthesiology and Ministries of Health should use this evidence-based document to help decision-making on how PSA should be performed in their countries. The final draft of the document was available to ESA members via the website for 4 weeks with the facility for them to upload their comments. Comments and suggestions of individual members and national Societies were considered and the guidelines were amended accordingly. The ESA guidelines Committee and ESA board finally approved and ratified it before publication.
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From the Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany (JH), Anaesthesiology Institute, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates (ML), Department of Clinical Sciences Malmö, Anaesthesiology and Intensive Care Medicine, Lund University Faculty of Medicine, Malmö, Sweden (JA), Centre for Evidence-Based Medicine, Faculty of Medicine, University of Lisbon, Lisbon, Portugal (JS,JC), Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples ‘Federico II’, Naples, Italy (EDR), Department of Anaesthesiology and Intensive Care, Hôpitaux Universitaires Paris Nord Val de Sein, Paris, France (DL), Clinical Department of Anaesthesiology and Intensive Care, University Medical Centre, Ljubljana, Slovenia (VNJ), Perioperative Medicine, Pain Therapy, RRS and Intensive Care Department, Anaesthesiology and Intensive Care University of Chieti-Pescara, Chieti, Italy (FP), Department of Anaesthesiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands (MMRFS), Anesthésie, Hôpital Jeanne de Flandre, Lille (FV), Fuchs-Buder T. Department of Anaesthesiology and Critical Carel, CHRU Nancy, University of Lorraine, Nancy, France (TFB); and Karl Landsteiner Institute for Anaesthesiology and Intensive Care Medicine, Vienna, Austria (RF)
*Chairman of the ESA/EBA taskforce for procedural sedation and analgesia guidelines in adults.
†Co-chairman of the ESA/EBA taskforce for procedural sedation and analgesia guidelines in adults.
Correspondence to Massimo Lamperti, Anaesthesiology Institute, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates Tel: +971 2 5019000x41090; fax: +971 2 4108374; e-mail: email@example.com
Published online 5 September 2017
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