Plain-English explanations of the technical terms and legislation used in this document.
- Academy of Medical Royal Colleges
- The body that brings together the UK's medical royal colleges and sets shared standards, including the national guidance on safe sedation.
- Advanced Life Support (ALS)
- An advanced level of resuscitation training covering the management of cardiac arrest and the seriously deteriorating patient.
- Airway
- The passage from the mouth and nose to the lungs through which a person breathes; keeping it open and clear is essential during sedation.
- Anaesthetist
- A doctor specially trained to give anaesthesia and to manage breathing, consciousness and vital functions during procedures.
- Anaphylaxis
- A severe, life-threatening allergic reaction needing immediate emergency treatment.
- Apnoea
- A pause or stop in breathing.
- ASA grade
- The American Society of Anesthesiologists physical status score, a simple grading of how fit a patient is, used to judge whether sedation is suitable.
- Aspiration
- Breathing stomach contents, fluid or other material into the lungs, which can cause serious harm.
- Bag-valve-mask
- A hand-held device with a mask and squeezable bag used to push oxygen into the lungs of a patient who is not breathing adequately.
- Baseline observations
- A patient's vital sign readings taken before sedation, used as the reference point to compare later readings against.
- Benzodiazepine
- A class of sedative medicine (for example midazolam) commonly used for conscious sedation; its effect can be reversed by flumazenil.
- Body mass index
- A measure of body weight in relation to height, used here as one indicator of sedation risk.
- Capnography
- Continuous measurement of the carbon dioxide a patient breathes out, used to detect breathing problems early.
- Cardiopulmonary resuscitation (CPR)
- Emergency chest compressions and rescue breaths given when a person's heart or breathing has stopped.
- Care Quality Commission (CQC)
- The independent regulator of health and social care services in England.
- Central nervous system
- The brain and spinal cord; sedatives work by reducing its activity, which calms the patient and can slow breathing.
- Conscious sedation
- A light, controlled level of sedation that keeps a patient relaxed and able to respond to speech while their breathing and reflexes are maintained.
- Contemporaneous
- Recorded at the time something happens, rather than written up later from memory.
- Controlled drug
- A medicine whose supply, storage and records are tightly restricted by law because of its potential for misuse.
- Decision making and consent
- General Medical Council guidance (2020) on how clinicians should share information with patients and obtain valid consent.
- Deep sedation
- A deeper level of sedation in which a patient is hard to rouse and their breathing may be at risk; it is outside the scope of this procedure.
- Defibrillator
- A device that delivers a controlled electric shock to the heart to restore a normal rhythm in certain cardiac arrests.
- Discharge criteria
- The set of objective checks a patient must pass before it is safe for them to leave after sedation.
- End-tidal carbon dioxide
- The level of carbon dioxide measured at the end of a breath out; a rising level can be an early sign of inadequate breathing.
- Endpoint
- The intended level of sedation aimed for during titration, here a calm, cooperative patient who still responds to speech.
- Escort
- A responsible adult who takes the patient home after sedation and stays with them.
- Fasting status
- Whether and for how long a patient has gone without food or drink before sedation, checked to reduce the risk of breathing in stomach contents.
- Flumazenil
- The reversal medicine that counteracts the effect of benzodiazepine sedatives.
- General anaesthesia
- A drug-induced, controlled state of unconsciousness for surgery, requiring an anaesthetist and full anaesthetic facilities; it is outside the scope of this procedure.
- General Medical Council (GMC)
- The body that registers doctors in the UK and sets the standards they must follow.
- Health and Social Care Act 2008 (Regulated Activities) Regulations 2014
- The regulations setting the fundamental standards that providers of regulated care must meet, enforced by the Care Quality Commission.
- Hepatic impairment
- Reduced liver function, which can affect how the body handles sedative drugs.
- Human Medicines Regulations 2012
- The main law governing how medicines are authorised, supplied and used in the UK.
- Hypoxia
- A lower-than-normal level of oxygen reaching the body's tissues.
- Immediate Life Support (ILS)
- A level of resuscitation training covering initial management of a cardiac arrest until an advanced team arrives.
- Informed consent
- Agreement to treatment given freely after the risks, benefits and alternatives have been clearly explained.
- Intravenous
- Given directly into a vein.
- Local anaesthesia
- Numbing of a specific part of the body for a procedure, without making the patient unconscious.
- Mallampati score
- A quick check of how much of the back of the mouth and throat can be seen, used to predict whether managing a patient's airway may be difficult.
- Mental Capacity Act 2005
- The law that protects and supports people who may be unable to make particular decisions for themselves.
- Misuse of Drugs Regulations 2001
- The law controlling how controlled drugs may be possessed, stored, supplied and recorded.
- Naloxone
- The reversal medicine that counteracts the effect of opioids, used for opioid-induced slowed breathing.
- Nasopharyngeal airway
- A soft tube passed through the nose to help keep a sedated patient's airway open.
- Obstructive sleep apnoea
- A condition in which the airway repeatedly narrows or closes during sleep, increasing the risk of breathing problems under sedation.
- Operating department practitioner
- A registered healthcare professional trained to support patients and the clinical team before, during and after procedures and anaesthesia.
- Operator (proceduralist)
- The clinician who actually carries out the procedure on the patient.
- Operator-sedationist
- A clinician who both performs the procedure and gives the sedation; in this situation a separate trained person must monitor the patient throughout.
- Opioid
- A class of strong pain-relieving medicine that can also slow breathing; its effect can be reversed by naloxone.
- Oropharyngeal airway
- A curved device placed in the mouth to help keep a sedated patient's airway open.
- Over-sedation
- Sedation that is deeper than intended, putting breathing, the airway and consciousness at risk.
- Oxygen saturation
- The percentage of oxygen carried in the blood, measured continuously during sedation.
- Pulse oximetry
- A painless clip-on monitor that measures oxygen levels in the blood and the pulse rate.
- Registered Manager
- The person registered with the regulator as responsible for the day-to-day running of a service.
- Regulated activity
- A type of care or treatment the law requires a provider to register with the regulator to deliver.
- Renal impairment
- Reduced kidney function, which can affect how the body handles sedative drugs.
- Respiratory depression
- Breathing that becomes too slow or too shallow to keep oxygen levels safe.
- Resuscitation Council UK
- The UK body that sets the standards and guidance for resuscitation practice and training.
- Reversal agent
- A medicine that counteracts a sedative or opioid to help manage over-sedation or slowed breathing.
- Safe Sedation Practice for Healthcare Procedures
- The Academy of Medical Royal Colleges standards and guidance setting out how sedation should be delivered safely.
- Sedationist
- The competent clinician responsible for planning and delivering the sedation.
- Standard Operating Procedure (SOP)
- A written, step-by-step instruction setting out how a particular task is to be carried out consistently and safely.
- Suction
- Equipment used to clear fluid, secretions or vomit from a patient's mouth and airway.
- Synergistic
- When two drugs together produce a greater combined effect than expected, here a stronger depression of consciousness and breathing.
- Titration
- Giving a drug in small steps, waiting for each to take effect, until the right level is reached, rather than one large dose.
- Venous thromboembolism (VTE)
- A blood clot that forms in a vein, which can travel to the lungs and become life-threatening.
- Vital signs
- Key measurements of body function such as pulse, blood pressure and oxygen levels.
- Yankauer sucker
- A rigid suction device used to clear the mouth and throat quickly.