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Table 2 Adverse events of anesthesia and sedation

From: Capnographic monitoring reduces hypoxia incidence in older patients undergoing gastrointestinal endoscopy under propofol sedation: study protocol for a multicenter randomized controlled trial

Step 1:Was there one or more adverse events associated with this sedation encounter?

□ No, this form is now complete.

□ Yes, fill out the remainder of the form below.

Step 2: Please DESCRIBE the adverse event(s). Check all that apply.

Minimal risk descriptors

Minor risk descriptors

Sentinel risk descriptors

□ Vomiting/retching

□ Oxygen desaturation (75–90%) for < 60s

□ Oxygen desaturation, severe (<75% at any time) or prolonged (<90% for >60s)

Other, specify below

□ Sub-clinical respiratory depressiona

□ Apnoea not prolonged

□ Apnoea, prolonged (>60s)

□ Muscle rigidity, Myoclonus

□ Airway obstruction

□ Cardiovascular collapse/shockg

□ Hypersalivation

□ Failed sedatione

□ Cardiac arrest/absent pulse

□ Paradoxical responseb

□ Allergic reaction without anaphylaxis

□ Recovery agitationc

□ Bradycardiatf

□ Prolonged recoveryd

□ Tachycardiaf

□ Hypotensionf

□ Hypertensionf

□ Seizure

Step 3: Please note the INTERVENTIONS performed to treat the adverse events(s). Check all that apply.

Minimal risk

Minor risk

Moderate risk

Sentinel intervention

□ No intervention performed

□ Airway repositioning

□ Bag valve mask-assisted ventilation

□ Chest compressions

Other, specify below

□ Tactile stimulation

□ Tactile stimulation

□ Laryngeal mask airway

□ Tracheal intubation

□ Additional sedative(s)

Or the administration of:

□ Ora/nasal airway

Or the administration of:

□ Antiemetic

□ Supplemental oxygen, new or increased

□ CPAP

□ Neuromuscular block

□ Antihistamine

□ Antisialogogue

Or the administration of:

□ Pressor/epinephrine

□ Reversal agents

□ Atropine to treat bradycardia

□ Rapid i.v.fluids

□ Anticonvulsant i.v.

Step 4: Please note the OUTCOME of the adverse events(s). Check all that apply.

Minimal risk outcome

Moderate risk outcome

Sentinel outcome

□ No adverse outcome

□ Unplanned hospitalization or escalation of careh

□ Death

Other, specify below

□ Permanent neurological deficit

□ Pulmonary aspiration syndromei

Step 5: Assign a SEVERITY rating to the adverse event(s) associated with this sedation encounter.

If there are any options checked in the Sentinel columns above, then this is a Sentinel adverse eventj.

If the most serious option(s) checked above are Moderate risk, then this is a Moderate risk adverse eventk.

If the most serious option(s) checked above are Minor risk, then this is a Minor risk adverse eventl.

If the most serious option(s) checked above are Minimal risk, then this is a Minimal risk adverse eventm.

  1. Footnotes:
  2. a “Sub-clinical respiratory depression” is defined as capnographic abnormalities suggesting respiratory depression that do not manifest clinically
  3. b “Paradoxical response” is defined as unanticipated restlessness or agitation in response to sedatives
  4. c “Recovery agitation” is defined as abnormal patient affect or behaviors during the recovery phase that can include crying, agitation, delirium, dysphoria, hallucinations, or nightmares
  5. d “Prolonged recovery” is defined as failure to return to baseline clinical status within 2 hours
  6. e “Failed sedation” is defined as inability to attain suitable conditions to humanely perform the procedure
  7. f Alteration in vitals signs (bradycardia, tachycardia, hypotension, hypertension) is defined as a change of >25% from baseline
  8. g “Cardiovascular collapse/shock” is defined as clinical evidence of inadequate perfusion
  9. h Examples of “escalation of care” include transfer from ward to intensive care, and prolonged hospitalization
  10. i “Pulmonary aspiration syndrome” is defined as known or suspected inhalation of foreign material such as gastric contents into the respiratory tract associated with new or worsening respiratory signs
  11. j “Sentinel” adverse events are those critical enough to represent real or serious imminent risk of serious and major patient injury. Once recognized, they warrant immediate and aggressive rescue interventions. Once clinically concluded, they warrant immediate reporting within sedation care systems and the highest level of peer scrutiny for continuous quality improvement
  12. k “Moderate” adverse events are those that, while not sentinel, are serious enough to quickly endanger the patient if not promptly managed. Once clinically concluded, they warrant timely reporting within sedation care systems and periodic peer scrutiny for continuous quality improvement
  13. l “Minor” adverse events are those encountered periodically in most sedation settings, and that pose little threat given appropriate sedationist skills and monitoring
  14. m “Minimal” adverse events are those that alone present no danger of permanent harm to the patient
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