Weekly outline

  • General

    • WELCOME REMARKS Forum

      Good day participants.

      It is my pleasure to welcome you to this course on Procedural Sedation.

      Sedation for patients needing diagnostic and therapeutic interventions has become a very important segment in the Services offered in  Philippine General Hospital.  The number of patients availing of Non-Operating Room Anesthesia (NORA) procedures has increased exponentially in the last few years.

      In conjunction with the PGH's efforts to upgrade and improve its equipment and facilities for patients requiring Diagnostic (MRI, CT Scan, Bone Scan, Endoscopy, etc.) and Therapeutic (LINAC, Brachytherapy, Pediatric Oncology etc.) procedures, it is our duty to maintain the highest level of care for these patients.

      It is the aim of this course to put us all-Anesthesia Providers on the same page.  In this course, we will all learn, explore, practice, and reflect on the important aspects of sedation, with the ultimate goal of standardizing, maintaining, and even improving our Anesthesia practice for safe and quality care for our fragile patients.

      Good luck and Enjoy!!!!

      Evangeline K. Villa, MD, DPBA, FPSA

      Chief, NORA Division 

      Department of Anesthesiology, UP-PGH

  • Educational Resources

  • Module 1: Levels of sedation

    In this module, the continuum of depth of sedation as defined by the American Society of Anesthesiologists will be discussed.

    • Continuum of Depth of Sedation/Analgesia URL

      * For better clarity, click 720p in your video setting.  Enjoy!!!

    • Exercises on Levels of Sedation URL
      Restricted Not available unless: The activity Continuum of Depth of Sedation/Analgesia is marked complete

      * For a better clarity while viewing, click the 720p in the video settings.  Good luck!!!

    • ASA Continuum of depth of sedation File 124.6KB PDF document

      This is a 2-page document from the American Society of Anesthesiologists defining the levels of sedation and general anesthesia.

    • ASA Position on Monitored Anesthesia Care File 83.1KB PDF document

      This is a 2-page document from the American Society of Anesthesiologists that defines and distinguishes monitored anesthesia care and moderate sedation/analgesia from each other. It highlights how these terms are used in their medical records in terms of ASA relative value guide for billing purposes and not to represent continuum of sedation.

      Monitored anesthesia care is a form of service provided by anesthesiologists that encompasses the continuum of sedation. 

  • Module 2: Pre-sedation assessment

    In this Module, the evaluation of patients prior to sedation will be discussed.

    • Pre-sedation Evaluation URL
      Restricted Not available unless: The activity Exercises on Levels of Sedation is marked complete

    • Pre-procedure Assessment URL
      Restricted Not available unless: The activity Pre-sedation Evaluation is marked complete

    • ASA Basic Standards for Preanesthesia Care File PDF document

      This is a 1-page document from the American Society of Anesthesiologists enumerating the responsibilities of an anesthesiologist before delivering anesthetic care.

    • Pregnancy testing prior to anesthesia and surgery File 204.3KB PDF document

      This is a 4-page document from the American Society of Anesthesiologists enumerating recommendations for pregnancy testing among patients who will require anesthesia.

  • Module 3: NPO Guidelines

    In this Module, the guidelines on fasting prior to a sedation procedure will be reviewed.

    • NPO Guidelines URL
      Restricted Not available unless: The activity Pre-procedure Assessment is marked complete

    • QUIZ ON NPO GUIDELINES URL
      Restricted Not available unless: The activity NPO Guidelines is marked complete

    • 2017 ASA Practice Guidelines for Preoperative Fasting File

      This is an 18-page document from the American Society of Anesthesiologists which is a 2017 updated report by the ASA Task Force on preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration as it applies to healthy patients undergoing elective procedures.

    • 2023 ASA Practice Guideline for Preoperative Fasting File

      This is a 20-page document from the American Society of Anesthesiologists. It is a modular update of the 2017 ASA practice guidelines for preoperative fasting. It also addresses the topics of carbohydrate-containing clear liquids with or without protein, chewing gum, and pediatric fasting duration.

  • Module 4: Preparation of NORA site prior to sedation

    In this module, the conduct of setting up your work area in a NORA site will be discussed.

    • Preparation of NORA site URL
      Restricted Not available unless: The activity QUIZ ON NPO GUIDELINES is marked complete

      * For better viewing clarity, click the 720p in the video settings.

    • NORA site tour 1 URL
      Restricted Not available unless: The activity Preparation of NORA site is marked complete

    • NORA site tour 2 URL
      Restricted Not available unless: The activity NORA site tour 1 is marked complete

    • NORA site tour 3 URL
      Restricted Not available unless: The activity NORA site tour 2 is marked complete

    • NORA site tour 4 URL
      Restricted Not available unless: The activity NORA site tour 3 is marked complete

    • NORA site tour 5 URL
      Restricted Not available unless: The activity NORA site tour 4 is marked complete

    • NORA site tour 6 URL
      Restricted Not available unless: The activity NORA site tour 5 is marked complete

    • NORA site tour 7 URL
      Restricted Not available unless: The activity NORA site tour 6 is marked complete

    • NORA site tour 8 URL
      Restricted Not available unless: The activity NORA site tour 7 is marked complete

    • NORA site tour 9 URL
      Restricted Not available unless: The activity NORA site tour 8 is marked complete

      EAR UNIT

      EAR UNIT

    • NORA site tour 10 URL
      Restricted Not available unless: The activity NORA site tour 9 is marked complete

    • NORA site tour 11 URL
      Restricted Not available unless: The activity NORA site tour 10 is marked complete

    • NORA site tour 12 URL
      Restricted Not available unless: The activity NORA site tour 11 is marked complete

    • ASA Standards on Non-Operating Room Anesthetizing Locations File 91.8KB PDF document

      This is a 2-page document from the American Society of Anesthesiologists which enumerates the recommended basic requirements for procedures intended to be performed outside an operating room.

  • Module 5: Not so physiologic effects of sedatives

    In this Module, you will learn the perturbances caused by sedation to the CNS, Respiratory, and Cardiovascular system.

    • Not so physiologic effects of sedatives URL
      Restricted Not available unless: The activity NORA site tour 12 is marked complete

      * Click 720p in your video settings for a clearer viewing experience.

  • Module 6: Monitoring during sedation

    The basic requirements for safe monitoring of patients undergoing sedation will be discussed.

    • Monitoring during sedation URL
      Restricted Not available unless: The activity Not so physiologic effects of sedatives is marked complete

    • Capnography Basics URL
      Restricted Not available unless: The activity Monitoring during sedation is marked complete

    • ASA Standards for Basic Anesthetic Monitoring File 145.4KB PDF document

      This is a 3-page document from the American Society of Anesthesiologists which enumerates the  standards for basic anesthetic monitoring.

  • Module 7: Post-sedation care

    In this Module, proper care after a sedation procedure will be discussed.

    • Post sedation care URL
      Restricted Not available unless: The activity Capnography Basics is marked complete

    • Post-sedation Care 2 URL
      Restricted Not available unless: The activity Post sedation care is marked complete

      For better clarity, click 720p in your video settings.

    • ASA Standards for Postanesthesia Care File 135.7KB PDF document

      This is a two-page document from the American Society of Anesthesiologists enumerating the standards for patients who received anesthetic care.  

    • PACU form File 278.7KB PDF document

      This is the current PACU form that we use for our patients who received anesthetic care.

    • Post sedation discharge instruction - Adult Patient File 367.5KB PDF document

      This is an example of a post-sedation discharge instruction for an adult patient.   

        

    • Post sedation discharge instruction - Pediatric Patient File 534.5KB PDF document

      This is an example of post-sedation discharge instruction for a pediatric patient.

  • July 24, 2021 Sedation Workshop Activities

    • Basic NORA Principles URL
      Restricted Not available unless: The activity Post-sedation Care 2 is marked complete

    • Sedation for Endoscopic Procedures: GI system URL
      Restricted Not available unless: The activity Basic NORA Principles is marked complete

    • Sedation for endoscopic procedures: Pulmonary System URL
      Restricted Not available unless: The activity Basic NORA Principles is marked complete

    • Sedation for Diagnostic and Interventional Radiology URL
      Restricted Not available unless: The activity Basic NORA Principles is marked complete

    • Sedation for Radiotherapy URL
      Restricted Not available unless: The activity Basic NORA Principles is marked complete

    • Sedation for interventional neuroradiology URL
      Restricted Not available unless: The activity Basic NORA Principles is marked complete

    • Sedation for Diagnostic and Interventional Cardiology URL
      Restricted Not available unless: The activity Basic NORA Principles is marked complete

  • July 31, 2021 Sedation Workshop Activities

    • Pediatric Pre-sedation Assessment URL
      Restricted Not available unless: The activity Basic NORA Principles is marked complete

    • Conduct of Pediatric Sedation URL
      Restricted Not available unless: The activity Pediatric Pre-sedation Assessment is marked complete

    • Adverse events & crisis management during pediatric sedation URL
      Restricted Not available unless: The activity Conduct of Pediatric Sedation is marked complete

  • CLOSING REMARKS

    My warmest greetings to all participants!!!

    First, congratulations to the Consultants, Fellows, and Residents, who exerted time and effort, shared their talents and expertise, and participated in making this Basic Course on Procedural Sedation a reality.

    Second, this activity again puts us in the map in our quest for Excellence in  providing safe and quality Patient Care.  This poses a challenge to the other Divisions for similar worthwhile ventures.

    Truly, providing Anesthesia Care to a wide range of patients (newborn to frail geriatric) for Diagnostic and Therapeutic procedures in several NORA sites in the Philippine General Hospital, has been a source of anxiety, not just for the Anesthesiologists, but for the whole Team caring for these patients.  Only recently has there been a close communication and coordination among stakeholders in these NORA sites, such that major improvements in terms of facilities and equipment have been realized for better services to our patients.

    Let's continue to learn, develop, improve, and implement clinical practice guidelines best suited to these challenging NORA procedures, to better prepare us educationally and psychologically to meet the increasing demands of NORA sites.

    Move forward mga ka-NORA!!!

    Grace Anne B. Herbosa, MD, DPBA

    Professor and Chair

    Department of Anesthesiology, UP-PGH