Sedation and Analgesia for Diagnostic and Therapeutic Procedures. Edited by Shobha Malviya, Norah Naughton, Kevin Tremper. Humana Press, Totowa, New Jersey, 2003. Pages: 310. ISBN: 0-89603-863-7. Price: $125.
The proliferation of diagnostic and therapeutic procedures outside of the traditional operating room environment has brought many challenges to the medical profession. Chief among these is the dilemma of how to provide sedation and analgesia for these varied patients and procedures in a safe environment, often outside of the care of traditional anesthesia providers. Realizing the need for safe and uniform practices, many professional societies have developed guidelines specific for the care of the sedated patient during these procedures. Regulatory agencies have embraced these concepts and have demanded that patients receive the same standard of care, including uniformity of assessments, monitoring, documentation, outcomes measurements, and credentialing and competency of staff, regardless of where or by whom sedation is administered in an institution.
In Sedation and Analgesia for Diagnostic and Therapeutic Procedures , the editors have recruited a variety of authors, including physicians, nurses, and scientists, to comprehensively review sedation and analgesia from all realms. The book begins with a short review of the basic physiology of the sedated state, progresses to various clinical guidelines for both the pediatric and adult patient population, and concludes with a very practical section on quality outcomes processes and measurements. Additional chapters included in this very concise and practical review of sedation and analgesia are devoted to pharmacology, assessments, monitoring, and recovery. Tables, graphs, and figures incorporated throughout the book highlight various protocols, regulatory requirements, guidelines, recommended drug dosages, monitoring requirements, and quality measurement tools. All of these will be valuable to a variety of professionals ranging from physicians, to nurses, to hospital administrators as they develop their own sedation and analgesia policies and guidelines.
There are some inconsistencies in the book regarding the depth of details on certain subjects and lack of breadth on other matters. For example, an entire chapter is devoted to opioids in the management of acute pediatric pain, but discussion of analgesia for the adult population is noticeably lacking. I found myself searching for an expansion on patient assessments, medication use, and potential complications associated with sedation and analgesia and wishing that less time had been spent on the differences between the pediatric and adult population regarding various guidelines, procedures, and sites. One example of this lack of consistency is the discussion of monitoring for sedation care; approximately 10 pages of a 26-page chapter are devoted to the use of pulse oximetry, whereas all other methods of monitoring are discussed in 7 pages.
Overall, editors Malviya, Naughton, and Tremper have produced a valuable, up-to-date, and practical resource for providers who deal with sedation care. Although the book is not intended to provide a thorough, in-depth scientific review of all the mechanisms of the sedated state or the obscure details of the different pharmacologic agents used in sedation and analgesia, it is an excellent reference. In the current medical environment in which sedation practices are increasing exponentially, this book is a very good resource for practitioners to ensure patient safety and high-quality outcomes when administering sedation and analgesia for this vast array of procedural practices. It is a must-read for anyone who is unfamiliar with the current sedation practices and guidelines promulgated by a number of national professional societies. The book contains sufficient information to help everyone ensure compliance with regulatory standards for sedation care.