Procedural Sedation and Analgesia (Adults)

Procedural Sedation and Analgesia (PSA) involve administering a sedative, and sometimes an analgesic (painkiller) to a patient undergoing a medical procedure that is uncomfortable or painful. You may not be completely unconscious or unaware of what is going on. Most procedures requiring PSA are carried out at the Endoscopy Suite, Diagnostic Imaging and Interventional Radiology Departments, or Day Surgery.

You may receive PSA as an inpatient or an outpatient. If you receive PSA as an outpatient, you can go home on the same day.

PSA medication is usually given directly into the vein as an injection. The medicines commonly used are midazolam and fentanyl. You will be monitored closely throughout the procedure.

Are There Any Side Effects?

Side effects of the medicines used in PSA include:

• Nausea and vomiting
• Coughing
• Headache
• Hiccups
• Prolonged drowsiness
• Respiratory depression
• Drop in blood pressure and heart rate

Generally, PSA is well tolerated. Most side effects are self-limiting and usually resolve after one to two hours, or after treatment. It is rare to develop a severe allergic reaction to the medicines used in PSA. Appropriate and prompt treatment will be given if this occurs.

Is Fasting Required?

Yes. For your safety, fasting to ensure an empty stomach is required to prevent stomach contents from entering your lungs while you are unconscious (aspiration).

• Generally, no food after 12 midnight.
  • If you are allowed breakfast, a maximum of 2 pieces of plain biscuits or plain bread can be consumed.
  • Avoid heavy and oily meals which increase the risk of vomiting and aspiration.
• Unless otherwise advised, only water is allowed after 12 midnight. It is advisable to limit water intake to a maximum of half a cup each hour.
• You may wish to write down the timing given to you:
  • Last meal to finish by __________h
  • Last water to finish by _________ h

If you have been instructed to take oral medications on the day of the procedure, you should still take them with sips of water while fasting from food.

Who is Not Suitable for PSA?

• A patient with known allergy to medicines used for PSA
• A patient who has taken a meal less than six hours before PSA
• A patient with an ongoing respiratory tract infection
• A patient with certain medical conditions considered inappropriate for sedation

If I Am Sick with Fever, Flu or a Runny Nose, Can I Undergo Sedation?

No. We will reschedule your appointment to at least two weeks after you have recovered from the acute illness.

Analgesia (Pain Relief) Following PSA

Pain relief is an important part of the procedure. Some procedures can be carried out under local anaesthesia alone without additional painkillers. Oral painkillers, if prescribed for you, should be taken as instructed.

Advice After PSA

• You may feel drowsy for a few hours following PSA.
• You must have a responsible adult accompany you home if you have had day surgery or an outpatient procedure.
• You can resume your normal diet once you have fully recovered from PSA.
• Please follow all discharge instructions.

For the 24 Hours After PSA, please:

• Do not drink alcohol
• Do not take any sedatives or tranquilisers
• Do not operate any machinery
• Do not handle any sharp item, dangerous tool or equipment
• Do not drive, ride a bike or motorcycle, swim or engage in sport activities
• Do not go to the toilet unattended
• Do not make important decisions or sign legal documents

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