Questions about the Practice Management Guidelines for Moderate Sedation and Analgesia

The recently published Practice Guidelines for Moderate Procedural Sedation and Analgesia 2018¹  are, considering an overall organization, excellent. They are clearly structured and truly offer a systematic framework for clinicians and administrators.

There are, however, three important points of concern:

1. On page 441 of the survey findings, the document states all four groups of surveyed specialists agreed that “in urgent or emergent situations, where complete gastric emptying is not possible, do not delay moderate procedural sedation based on fasting time alone.” This message also is reflected on page 442 of the recommendation for preprocedural patient preparation, regarding fasting. The conclusions and recommendation are incorrect: The actual surveys showed that all groups had higher “nonagreement rate” regarding the practice (see question 10 of all surveyed physicians), and the members of American Society of Dentist Anesthesio logists had the highest disagreement.

2. On page 447, “Sedatives/Analgesic Medications Intended for General Anesthesia,” point two of the actual recommendations, the message delivered may be confusing. According to the guidelines statement, practitioners are able to provide moderate sedation and potentially general anesthesia as long as they have the skills and they are able to care for their patients. What is then the definition of practitioners? What is the role of anesthetists and anesthesiologists in such regards? What are the requirements for nonanesthesiologists to be licensed in providing such care?

3. The guidelines claim involvement of various societies and groups of practitioners. The surveys, however, did not include the American College of Radiology or the Society for Interventional Radiology. The authors are asked to comment.

I commend again the authors and the American Society of Anesthesiologists task force for the incredible work and comprehensive clinical guidelines, yet there are critical concerns that need to be addressed.

The author declares no competing interests.