Non-anaesthetist sedation


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I read with interest the articles by Edwards et al. [1] and Chambers and Patey [2], on the use of sedation by non-anaesthetists and the associated correspondence by Dr Hunter [3]. I would agree with Dr Hunter that there is a misconception that sedation is a very safe procedure and a significant problem with suboptimal sedation by non-anaesthetists. Good sedation is trickier than general anaesthesia, but saying that general anaesthesia is safer than sedation is, in my view, incorrect.

Sedation with agents like propofol can be safely administered by emergency physicians [4, 5], and in reality the majority of sedation is performed by dentists and emergency physicians, suggesting that a 15-fold higher risk of mortality than general anaesthesia might be an exaggeration.

A more serious issue is the identification of those non-anaesthetists who administer sedation, and the level of formal training and supervision they receive. There is large variation within this group; therefore, categorising them into a large group of so-called ‘non-anaesthetists’ is, in my view, not helpful, and does not provide useful information allowing a change of practice.

We should aim to increase training opportunities for specialists and anaesthetists to teach good and safe sedation practice. Dr Hunter is right that we should not lower standards, but this should be with the help of other hospital practitioners, not despite them. Anaesthetists have a duty to be involved in such training, to improve and reduce the possible complications of sedation administered by non-anaesthetists.

Dr Hunter’s suggestion that the FRCA should be the minimum requirement for sedation is inappropriate, considering the number of procedures requiring sedation. However, specific sedation training with recording of cases would be appropriate for trainees who are expected to perform sedation in their day-to-day practice. In the UK, these measures are in progress with acute common stem trainees during their anaesthetic training. Another possibility would be to write local sedation guidelines with the various relevant specialties and review practice regularly. These measures would also permit the sedationists to audit practice and perform risk management analysis.

The medical community needs to step away from specialty-related arguments and do what is best for our patients; patient safety is the common interest we all share as specialists.

No external funding or conflicts of interest declared. Previously posted at the Anaesthesia Correspondence website: