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Verdoving buiten de operatiekamer

Some medical procedures and examinations cause pain, stress and anxiety. By receiving sleep medication and pain relief (PSA) beforehand, you will not feel any pain or anxiety, so that you can comfortably undergo the procedure or examination. This leaflet contains useful information on PSA to prepare you for a procedure under anesthesia outside the operating room.

What is PSA?

The abbreviation PSA stands for procedural sedation and/or analgesia. Sedation literally means lowering of consciousness until you feel sleepy and comfortable. This is done by administering sleep medication or sedatives, often in combination with painkillers (analgesics).
How deeply you are sedated depends on a number of factors: how sensitive you are to the medication, the choice of medication, the method of administration and which medication is chosen. Deeper sedation will be chosen for some procedures, while for others milder sedation will suffice.

What are the effects of PSA on your body?

  • It will make you sleepy and drowsy. Therefore, you will not consciously experience the procedure. Sometimes you will have forgotten what happened afterwards.
  • The pain stimulus will be suppressed by the painkiller (the analgesic): you will feel less pain or none at all.
  • Your reflexes, such as breathing and swallowing, will not be affected. In principle, you can be woken up; this is comparable to sleeping. So you will not be under general anesthesia.
  • Nausea does not occur often.

The main difference compared to general anesthesia is that, although you are asleep, you breathe on your own and protective body reflexes, such as coughing and swallowing, are unaffected. When you are under general anesthesia, your consciousness is significantly reduced which suppresses breathing and reflexes to such an extent that your airways and breathing need to be controlled. Therefore, general anesthesia requires many more measures before and after the procedure.

For which procedures is PSA used?

PSA is used for a variety of procedures. As a patient, you can also request PSA yourself. The most common procedures involving PSA in adults are: endoscopic techniques such as colonoscopy, gastroscopy, examination of the bile ducts (ERCP), gynecological examinations, lung examinations and the treatment of cardiac arrhythmia by means of electric shock.

How safe is PSA?

PSA is safe in healthy individuals. While you are sedated, the sedation specialist will closely monitor your body's vital functions, such as breathing, circulation and consciousness.
It is possible that you are part of a risk group. Examples of risk groups are people who:

  • are overweight;
  • are underweight;
  • have disorders affecting the head/neck area;
  • have chronic heart and lung problems;
  • have previously had negative experiences during PSA or general anesthesia.

The healthcare provider responsible for your sedation will assess whether you are part of a risk group beforehand. He/she will do this by asking you questions about your physical condition. He/she will also perform a physical examination, during which he/she will check your heart, lungs and airways. The healthcare provider will discuss the risk assessment with you and choose which form of PSA is most suitable for you.
The physician who performs the procedure also has final responsibility for the PSA. In some cases, the physician will transfer this task to someone else who will monitor you and respond to any complications.

You help decide

As a patient, you help decide about the most suitable form of PSA for you and give your consent to receive PSA during the procedure. In order to be able to make a well-considered decision, it is important that you receive the right information. You can expect to receive the following information from your healthcare provider:

  • the aim of the proposed form and the expected result;
  • the type of PSA (how deeply you’ll be sedated);
  • any side effects;
  • the pros and cons;
  • the risks;
  • other possible forms of PSA.

You will receive this information from the physician who is treating you or from another healthcare provider, such as a specialized nurse or sedation specialist.

Patients with an intellectual disability

For patients with an intellectual disability, careful consideration should be given to whether it is better to perform a procedure under PSA or under general anesthesia. In some cases, general anesthesia may be preferred to PSA. The healthcare provider will discuss this with the patient as well as his/her legal representative.

Preparation

You have to fast before having PSA administered, in order to prevent serious complications.

Fasting means:

  • A light breakfast such as two rusks or two crackers or one slice of bread up to six hours before admission time.
  • Drink only clear fluids (tea, water or apple juice) up to two hours before admission time.
  • Do not drink anything during the two hours before you are admitted to the hospital.
Example
You are expected at the hospital at 15:00. This is referred to as the admission time. In this case, you may not eat anything after 9:00, and you may not drink anything after 13:00.
Your healthcare provider will give you precise instructions on what you may and may not eat and drink before the procedure.

Administration

The sleep medication or sedatives and painkillers, if applicable, will be administered by infusion via an intravenous catheter (IV) inserted beforehand. This IV allows the medication to be administered drop by drop until the correct level of PSA has been reached. The way you respond to the sedative and painkillers, where applicable, will be monitored carefully during the procedure.

After the procedure

When the physician treating you has completed the procedure, the administration of the sleep medication will be discontinued. You will wake up shortly afterwards. After the procedure, you will be taken to the recovery room, where you will be cared for and monitored until you have woken up completely.
The nurses will then check your heart rate, blood pressure and responsiveness. The nurse will remove the infusion needle before you go home. After a certain period of time, you will be allowed to leave the department. You will usually be able to go home the same day (under supervision), unless the doctor has made other arrangements with you.
The medications given to you may continue to affect your judgment for several hours. Therefore, you are advised NOT to do the following during the first 24 hours after the procedure:

  • Drive a car or any other vehicle.
  • Operate dangerous machinery.
  • Make important decisions, such as those concerning financial obligations.
  • Consume alcoholic beverages.

You also need to have someone with you (at home) for the first 24 hours after the procedure so that he/she can help you and care for you if necessary.

PSA during admission

If you have been admitted to Isala, the nurses from your nursing department will come and get you after the procedure. Your treating physician will inform you of the results of the examination once you have returned to your department.

Contact

If you have any questions after reading this information, or would like to find out more, please contact the Anesthesiology outpatient department at (038) 424 21 39. We are available weekdays from 8:00 to 12:15 and from 12:45 to 16:30.

Do you have an appointment in the near future? Check your appointment confirmation to see when and where you are expected.

23 november 2018 / 7999

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