Procedural Sedation - safe drugs to use in rural area

[futuredoc206]

Hello all, 

I am soon starting my practice at a rural hospital with no RT

which drugs are safer to use for procedural sedation in that case?

I might be the only doctor and there might be only one nursing staff available 

Thanks 

[bearded frog]

2 hours ago, futuredoc206 said:

Hello all, 

I am soon starting my practice at a rural hospital with no RT

which drugs are safer to use for procedural sedation in that case?

I might be the only doctor and there might be only one nursing staff available 

Thanks 

This is probably not the place to be asking important clinical questions like that...

[hopeful_med]

I hope this is a troll post. If you are asking this question... should you be doing procedural sedation? 

Do you have relevant training in how to manage situations like airway obstruction, aspiration, hemodynamic instability, etc that comes with sedation? If not, its unsafe, bordering on malpractice.

[LostLamb]

Sadly i do not think this is a troll post. 

[AlexMD]

On 8/25/2022 at 5:56 PM, futuredoc206 said:

Hello all, 

I am soon starting my practice at a rural hospital with no RT

which drugs are safer to use for procedural sedation in that case?

I might be the only doctor and there might be only one nursing staff available 

Thanks 

Working in a rural setting definitely comes with its own set of challenges, but this should never impact whether or not you should proceed with procedures/interventions you do not feel adequately trained for.

 

I encourage you to look into proper CME activities regarding procedural sedation / airway management either through your College. This will be a great way to cumulate CME and gain proper knowledge/experience *if there is a practice component*

[Arztin]

On 8/25/2022 at 5:56 PM, futuredoc206 said:

Hello all, 

I am soon starting my practice at a rural hospital with no RT

which drugs are safer to use for procedural sedation in that case?

I might be the only doctor and there might be only one nursing staff available 

Thanks 

If this is a serious question I will say the following.

Asking such a question means you probably don't have enough knowledge nor experience with procedural sedation to perform it safely without supervision, especially in a setting with no backup nor RT. Therefore, I think you shouldn't be doing procedural sedations in such a setting, with your current knowledge. Any common medication used can be safe and unsafe depending on a bunch of factors: experience with the drug, dose, age and comorbidities, duration of sedation, clinical state of the patient, the procedure itself etc... It can be a risky procedure that can lead to severe complications that you should be ready to deal with. As someone who does it pretty much on a weekly basis, I still sometimes ask a colleague of mine to sedate while I do a procedure for higher risk patients, and I'm ready to call the anesthesiologist if it's a very high risk situation. The airway is no joke.

If it's absolutely something you need to do in your practice, please do a rotation in anesthesia and rotations in ED where you will learn how to do it. If you are an attending, take CME classes, and if you can, do some extra training as a resident.

[hopeful_med]

Plus, our CAS guideline (Canadian Anesthesiologist Society) states that you can't simultaneously do sedation (anything more than topical or po benzo) and a procedure simultaneously. So if things go south, it is indefensible. Thats why in emerg, most times there are two physicians, one solely for sedation and the other procedure (at least thats what I believe. I am anesthesia, not emerg so correct me if I am wrong)

[1D7]

3 hours ago, hopeful_med said:

Plus, our CAS guideline (Canadian Anesthesiologist Society) states that you can't simultaneously do sedation (anything more than topical or po benzo) and a procedure simultaneously. So if things go south, it is indefensible. Thats why in emerg, most times there are two physicians, one solely for sedation and the other procedure (at least thats what I believe. I am anesthesia, not emerg so correct me if I am wrong)

Most advanced interventional/endoscopic procedures (IR, GI, cards) have no anesthesiologist or other second physician present. Procedural sedation is ordered by the proceduralist physician and administered/monitored by an experienced nurse. I believe OMFS also provides office-based procedural sedation for dental procedures.

That said, there should be someone in the building who can help secure an airway, and the proceduralist should have reversal agents and a crash cart close by.