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Chapter 14
be available within 1-5 minutes. He is consulted for advice and is present during PSA for
patients with ASA 3 and 4 classifications, complex cases otherwise, or emergency situations.
The SP performs the preoperative screening of the patients scheduled for PSA. ASA 1 and
2 patients are usually screened only on paper. Further clinical assessment of e.g. the airway
will be done just before the procedure. ASA 3 and 4 patients are usually seen in the pre-
operative assessment clinic either by an anaesthesiologist, anaesthetic trainee or by the SP.
Standard rules for pre-anaesthetic fasting is followed. No analgesia or sedatives are given
for premedication.
Patients receive standard monitoring: ECG, SpO
2
, NIBP, and end-tidal carbon dioxide (etCO
2
)
according to the Dutch PSA guideline.
8
A SURPASS checklist
9
is performed by the entire
team before the start of the sedation. Sedative and analgesic drugs are chosen by the
discretion of the SP. The SP is also responsible for the patient on the recovery unit.
Data collection with the adverse event-reporting tool
For this study, the adverse event-reporting tool from the ISTF of the World SIVA
7
was
translated to Dutch. An electronic or paper based version of the tool could be used
according to the preference of the participating centre. Data was reported by the SP at the
end of the procedure, with help of the electronic anaesthetic case notes with automated
registration of vital signs. Patient age, ASA classification, medical history, method of pre-
assessment, type of procedure, urgency classification of the procedure, presence of an
anaesthesiologist, and anaesthetic drugs used were recorded.
Definitions
Definitions for sentinel, moderate, minor and minimal descriptors, interventions and
outcomes are based on the definitions made by Mason et al.
7
Sentinel risk descriptors are:
Severe or prolonged oxygen desaturation: any oxygen saturation (SpO
2
) <75% or SpO
2
<85% for >60 s;
Prolonged apnoea: cessation of respirations for >60 s;
Aspiration: inhalation of foreign material such as gastric contents into the respiratory tract;
Cardiovascular collapse or shock: clinical evidence of inadequate perfusion;
Cardiac arrest: absent pulse.
Sentinel interventions
are chest compressions, tracheal intubation, or the administration of
neuromuscular blockers, vasopressors including epinephrine, ephedrine, phenylephrine,
noradrenaline, or atropine for bradycardia.