الفهرس 
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Abstract
The American College of Emergency Physicians (ACEP) defines procedural sedation as ”a technique of administering sedatives or dissociative agents with or without analgesics to induce a state that allows the patient to tolerate unpleasant procedures while maintaining cardiorespiratory function. Procedural sedation and analgesia (PSA) is intended to result in a depressed level of consciousness that allows the patient to maintain oxygenation and airway control independently.”
The number of noninvasive and minimally invasive procedures performed outside of the operating room has grown exponentially over the last several decades. Sedation, analgesia, or both may be needed for many of these interventional or diagnostic procedures. Sedation and analgesia introduces an independent risk factor for morbidity and mortality in addition to the procedure itself. Medications that elicit pharmacologic effects, such as anxiolysis, amnesia, or analgesia, provide patient comfort during various procedures.
Procedural sedation, previously incorrectly referred to as ’conscious sedation,’ refers to techniques, medications, and maneuvers performed to help a patient tolerate unpleasant or painful procedures, avoiding potential unwanted memories associated with such procedures.
Because the proper use of Procedural sedation also aims to decrease the patient’s perception of pain and is generally obtained through the administration of analgesics combined to a sedative, PS can also serve as procedural sedation analgesia. Furthermore, PS also increases the likelihood of a successful procedure while decreasing the time required performing it. Additionally, Procedural sedation increases safety for the patient and personnel attending the patient. These approaches include medications, psychological techniques, and/or physical maneuvers to achieve the indented effect.
It is essential to understand that sedation, dissociation, and analgesia are separate concepts. Sedation is enabling the patient to lie very still; analgesia is pain relief by central or peripheral interventions, while dissociation is the production of a state of mind-body separation. As a consequence, Procedural sedation is not general anesthesia or pain control alone, but it is explainable as a tailored approach to the patient, based on anxiety level and pain aimed at achieving optimal sedation and analgesia for performing noninvasive and minimally invasive procedures, conducted primarily in contexts outside of the operating theater such as emergency, dentistry, radiology, and gastrointestinal endoscopy.
Because the most severe complication is a respiratory failure from airway obstruction or hypoventilation, intimate knowledge of airway anatomy, its variations, and any history of airway anomalies is mandatory. A careful assessment is mandatory for evaluating potential difficulties to ventilate. This assessment should include the presence of any anatomic features that may affect airway management, including dysmorphic or asymmetrical facial features, beard, significant malnutrition or cachexia with sunken cheeks and missing teeth, facial trauma (e.g., lacerations through the cheek or unstable bony injuries).
Procedural sedation and procedural sedation analgesia are indicated any time the patient requires an intervention that will cause significant discomfort. The level of sedation needed depends on the amount of pain the patient is likely to experience, and the necessity of the patient remaining still during the procedure. For instance, an orthopedic procedure that requires joint reduction, and thus muscle relaxation will require deeper sedation than a less uncomfortable procedure. Decision-making also has to take into account the vital signs of stability of the patient. For example, a patient who cannot tolerate cessation of breathing or a DROP in blood pressure may be better handled using a dissociative agent rather than moderate to deep sedation.