Procedural sedation causes a range of side effects from minor to serious. To prevent complications the staff providing procedural sedation performs continuous patient monitoring. The American Association of Nurse Anesthetists recommends that patients learn about procedural sedation before undergoing procedures which require sedation. A patient's general health impacts sedation side effects. A full health disclosure to the patient's physician, to include past medical history and medications, helps to ensure a safe outcome following procedural sedation.
Nausea and Vomiting
Billie Ann Wilson, PhD., Margaret Shannon, PhD., and Kelly Shields PharmD., authors of "Pearson Nurse's Drug Guide 2010", discuss the common side effects of procedural sedation such as nausea and vomiting. Nausea and vomiting occurs during or following sedation. The hazard of choking exists because sedation suppresses a patient's gag reflex. For this reason, patients do not eat or drink prior to receiving procedural sedation. To control nausea and vomiting, patients may receive medications called anti-emetics. Following the procedure, patients should drink clear liquids for the first few hours to decrease the risk of nausea and vomiting.
Aspiration
Sedation suppresses the gag reflex. In addition to vomit posing a risk for choking, called aspiration, oral secretions may pool in the back of the throat and be aspirated during inspiration. Kathleen Ouimet Perrin, PhD, author of "Understanding the Essentials of Critical Care Nursing", stresses the availability of functioning and readily accessible suction equipment during procedural sedation.
Low Blood Pressure
Hypotension, called low blood pressure, commonly occurs during procedural sedation. Scott and White Hospital recommends patients provide the doctor with a list of routine medications prior to the procedure because patients may be instructed to hold certain medications which may worsen hypotension. Patients remain in the procedural recovery area following sedation until blood pressure returns to the patient's pre-procedure readings.
Impaired Judgment
Sedation impairs coordination and judgment and places patients at risk for injury. Scott and White Hospital instructs patients not to driving or operate machinery and not to make important decisions for at least 24 hours following procedural sedation. Patients require a caregiver on the day of the procedure to help with daily activities such as maneuvering stairs, cooking and taking medications.
Arrhythmias
An adverse side effect of procedural sedation is an irregular heart rate, referred to as an arrhythmia. The Society of Critical Care Medicine explains that bradycardia, a slow heart rate less than 60 beats per minute, commonly occurs during sedation. In the event this adverse side effect occurs, procedural sedation staff provides supplemental oxygen. If the heart rate does not recover from oxygen therapy alone, the doctor or anesthesiologist reduces the sedation or stops the procedure. Rarely, procedural sedation induces life threatening arrhythmias such as ventricular tachycardia or ventricular fibrillation.
References
- American Association of Nurse Anesthetists: "Conscious Sedation: What Patients Should Expect"
- "Pearson Nurse's Drug Guide 2010"; Wilson, B. A., Shannon, T. M., & Shields, K. M.; 2010
- "Understanding the Essentials of Critical Care Nursing"; Kathleen Ouimet Perrin, PhD; 2009
- Scott and White Hospital; "Conscious Sedation"
- "Fundamental Critical Care Support (4th ed.); Society of Critical Care Medicine; 2007
