Deep Sedation by nurses? (2024)

So I want to check that I’m not being gaslit by the admin at one of the main hospitals I work at- they are saying nurses (not CRNAs) can do deep sedation for cases like D&Cs, radiology, etc.

This is mostly driven by the proceduralists not wanting to fit into the allotted times that the group is providing a CRNA (and not wanting to show up on time, but rather late… all the time). Also, not wanting to wait for a CRNA to be available when they want to do a case…

Last I checked and remember, any level of sedation deeper than moderate sedation is a MAC and requires an anesthesia provider… right?

Has something changed?

Arantius said:

So I want to check that I’m not being gaslit by the admin at one of the main hospitals I work at- they are saying nurses (not CRNAs) can do deep sedation for cases like D&Cs, radiology, etc.

This is mostly driven by the proceduralists not wanting to fit into the allotted times that the group is providing a CRNA (and not wanting to show up on time, but rather late… all the time). Also, not wanting to wait for a CRNA to be available when they want to do a case…

Last I checked and remember, any level of sedation deeper than moderate sedation is a MAC and requires an anesthesia provider… right?

Has something changed?

Click to expand...

MAC means nothing more than that the patient is being monitored by "anesthesia". It does NOT define level of sedation.

Sedation goes from light/mild, to moderate, to deep, to general anesthesia. Someone providing sedation needs to be qualified to handle "one deeper" than what they're supposed to be doing, meaning if the nurse is providing moderate sedation, (s)he needs to be able rescue a patient that accidentally drifts into the level of deep sedation. If someone is providing deep sedation, they need to be capable of handling a patient under general anesthesia to rescue them.

No, nurses are not qualified to be regularly and intentionally providing DEEP sedation.

"Because sedation is a continuum, it is not always possible to predict how an individual patient will respond. Hence, practitioners intending to produce a given level of sedation should be able to rescue patients whose level of sedation becomes deeper than initially intended. Individuals administering Moderate Sedation/Analgesia (Conscious Sedation) should be able to rescue patients who enter a state of Deep Sedation/Analgesia , while those administering Deep Sedation/Analgesia should be able to rescue patients who enter a state of general anesthesia."

"Minimal Sedation (Anxiolysis) = a drug-induced state during which patients respond normally to verbal commands. Although cognitive function and coordination may be impaired, ventilatory and cardiovascular functions are unaffected.

Moderate Sedation/Analgesia (Conscious Sedation) = a drug-induced depression of consciousness during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation. No interventions are required to maintain a patent airway, and spontaneous ventilation is adequate. Cardiovascular function is usually maintained.

Deep Sedation/Analgesia = a drug-induced depression of consciousness during which patients cannot be easily aroused but respond purposefully following repeated or painful stimulation. The ability to independently maintain ventilatory function may be impaired. Patients may require assistance in maintaining a patent airway, and spontaneous ventilation may be inadequate. Cardiovascular function is usually maintained.

General Anesthesia = a drug-induced loss of consciousness during which patients are not arousable, even by painful stimulation. The ability to independently maintain ventilatory function is often impaired. Patients often require assistance in maintaining a patent airway, and positive pressure ventilation may be required because of depressed spontaneous ventilation or drug-induced depression of neuromuscular function. Cardiovascular function may be impaired."

Arantius said:

So I want to check that I’m not being gaslit by the admin at one of the main hospitals I work at- they are saying nurses (not CRNAs) can do deep sedation for cases like D&Cs, radiology, etc.

This is mostly driven by the proceduralists not wanting to fit into the allotted times that the group is providing a CRNA (and not wanting to show up on time, but rather late… all the time). Also, not wanting to wait for a CRNA to be available when they want to do a case…

Last I checked and remember, any level of sedation deeper than moderate sedation is a MAC and requires an anesthesia provider… right?

Has something changed?

Click to expand...

It means they are to give 10 of versed and 400 of fent

Hoya11 said:

It means they are to give 10 of versed and 400 of fent

Click to expand...

Yup. Maybe remimazolam crap. Make sure that you are clear that this is not a good idea AND that you will not take ANY oversight or ownership of this process in any way. They will try to rope you in medicolegally.

What do the faculty sedation guidelines say about non-anesthesia sedation?

What do the med staff bylaws and privileging documents say about supervising sedation?

GassYous said:

Why are they talking to you about it? They can do whatever they want. But they shouldn't expect you to be immediately available for the inevitable complications.

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They asked my thoughts because I guess I’m one of the more “approachable” docs. It’s 100% loc*ms at that site so no leadership in anesthesia. I did say I will not be anywhere near this and they could pay me a consulting fee for any duties above clinical, like asking me to opine on this…. There’s a reason they can’t hire anyone full time