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Chapter 1
TheMinistryofHealth,WelfareandSport in theNetherlands adopted2012national guidelines
on an assessment framework for sedation and analgesia outside the OR. Providers offering
sedation outside the OR have to fulfil clearly defined structural requirements concerning
sedation focussing on optimal procedural success and patient safety and comfort. One of
the most important points was the introduction and legalisation of a structured education
and training program for specialised non-physician sedation practitioners.
In cooperation with the University Medical Centre of Utrecht (UMCU), the Academic
Medical Centre of Amsterdam (AMC) started for anaesthesia nurses a theoretical and on-
the–job training program lasting one year. After successfully passing a final examination
these specialised sedation practitioners work self-dependent under indirect supervision of
an anaesthesiologist on the different locations outside the OR where they provide sedation
ranging from mild over moderate to deep sedation levels, but no general anaesthesia.
It is important to know before reading this thesis that in the AMC the step - not only out
of the OR - but also out of the circle of anaesthesiologists towards specialised sedation
practitioners has been made already years ago. Today, both parties provide sedation
outside the OR, but only anaesthesiologists give general anaesthesia.