Standard 3: Post-procedure

Ensure appropriate patient monitoring and the use of discharge criteria.

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While a patient is still sedated after their procedure, airway obstruction remains a significant risk. Close respiratory and cardiovascular monitoring is needed from appropriately trained staff who can detect and respond to patient instability or deterioration.

Discharge from the recovery area should be criteria led, and the proceduralist and sedationist should be informed. The patient or carer should be actively engaged by the clinical team when determining a plan and timeline for discharge.

Designated area

Administer procedural sedation in a dedicated room and standardised environment to ensure the proper management of the patient and reduce complications.1,2

The patient may recover in the procedural area or be moved to a designated recovery area or formal post-anaesthesia recovery room. The recovery area should be close to the procedural area and be adequate to manage a medical emergency, with access to the necessary equipment.

Resources

PS55 Position statement on minimum facilities for safe administration of anaesthesia in operating suites and other anaesthetising locations 2021
Guidance on minimum requirements to be provided by healthcare facilities for safe administration of sedation.
Source: Australian and New Zealand College of Anaesthetists

Monitoring requirements

All episodes of procedural sedation require patient monitoring, but precise requirements will vary according to the clinical context.

All episodes should include the following:

  • Continuous pulse oximetry until the patient is conscious and easily rousable.
  • Heart rate and blood pressure monitoring at least every 15 minutes.
  • Oxygen may be required and should be available.
  • Appropriate reversal drugs and resuscitation equipment should be immediately available.

Staff with adequate training and support

To ensure patient safety through post-sedation recovery:

  • the staff responsible for caring for patients recovering from sedation should be appropriately trained
  • there should be ready access to supervising medical staff when needed
  • adequate staffing and facilities must be available if the patient has become unconscious or experienced other complications during the procedure.

Resources

PS04(A) Position statement on the post-anaesthesia care unit 2020
Guidance on training and support for post-sedation care.
Source: Australian and New Zealand College of Anaesthetists

More about clinical roles for sedation

Discharge planning and arrangements

Patients should be monitored after the procedure until they meet all relevant discharge criteria,3 including the resolution of respiratory depression; return of their vital signs to pre-sedation levels; and recovery to an alert, age-appropriate baseline level of consciousness.3–5

Post-sedation monitoring should include at least blood pressure and pulse oximetry.1,4

Discharge criteria should be developed locally, in co-operation with procedural teams and anaesthesia departments.2,4 The Modified Aldrete is one scoring system that can be used to assess a patient’s readiness for discharge.6

Patients should be discharged home under the care of a responsible adult.

Local departments should provide written care instructions to patients on discharge in their chosen language. Include information about water and food intake, emergency contacts and driving restrictions.1

Resources

Patient Discharge Documentation Guideline (GL2022_005)
This guideline outlines the documentation required when discharging admitted patients from NSW public hospitals.
Sources: NSW Health

A locally agreed plan should determine the requirements for transferring the patient to a higher level of care.

References

  1. Hinkelbein J, Lamperti M, Akeson J, et al. European Society of Anaesthesiology and European Board of Anaesthesiology guidelines for procedural sedation and analgesia in adults. Eur J Anaesthesiol. 2018;35(1):6-24. DOI: 10.1097/eja.0000000000000683
  2. Kim SH, Moon YJ, Chae MS, et al. Korean clinical practice guidelines for diagnostic and procedural sedation. Korean J Anesthesiol. 2024;77(1):5-30. DOI: 10.4097/kja.23745
  3. Practice Guidelines for Moderate Procedural Sedation and Analgesia 2018: A Report by the American Society of Anesthesiologists Task Force on Moderate Procedural Sedation and Analgesia, the American Association of Oral and Maxillofacial Surgeons, American College of Radiology, American Dental Association, American Society of Dentist Anesthesiologists, and Society of Interventional Radiology. Anesthesiology. 2018;128(3):437-79. DOI: 10.1097/aln.0000000000002043
  4. Dobson G, Chong MA, Chow L, et al. Procedural sedation: a position paper of the Canadian Anesthesiologists' Society. Can J Anaesth. 2018;65(12):1372-84. DOI: 10.1007/s12630-018-1230-z
  5. Miller KA, Andolfatto G, Miner JR, et al. Clinical Practice Guideline for Emergency Department Procedural Sedation With Propofol: 2018 Update. Ann Emerg Med. 2019;73(5):470-80. DOI: 10.1016/j.annemergmed.2018.12.012
  6. Ding D, Ishag S. Aldrete Scoring System. Treasure Island, Florida: StatPearls Publishing; Jul 2023.
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