Procedural Sedation

Procedural sedation requires achieving moderate (conscious) sedation—where patients remain responsive and protect their airways—through meticulous pre-procedural assessment, continuous monitoring by a dedicated provider, and careful drug titration. Mastery demands pharmacological knowledge, airway management skills, and readiness to rescue patients from unintended deeper sedation levels at any moment.

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Deep Sedation

Deep sedation suppresses consciousness so patients respond only to painful stimuli. Airway and ventilation may be compromised. Achieve it with propofol or ketamine, mandatory capnography, and preoxygenation. Airway rescue equipment must be ready. Unlike conscious sedation, deep sedation requires two providers and carries general anesthesia‑level risks.

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Conscious Sedation

Conscious sedation is a drug-induced state where patients respond purposefully to commands and maintain their airway. Achieve it by patient selection, slow IV titration (e.g., midazolam, propofol), continuous monitoring (SpO₂, capnography), and rescue readiness. Avoid deep sedation by frequent verbal assessment.

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Video Laryngoscopy

Video laryngoscopy offers a superior glottic view without aligning oral, pharyngeal, and laryngeal axes. Ideal for difficult airways, cervical spine precautions, and teaching, VL is a powerful rescue and primary tool. Master tube delivery—the view is only half the battle.

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Difficult Airway Algorithm

ASA Difficult Airway Algorithm. Pathway A: Anticipated Difficult Airway

The Difficult Airway Algorithm provides a structured rescue roadmap from airway assessment to CICO crisis. Master the two pathways: anticipated (awake intubation) and unanticipated (optimize, limit attempts, ventilate, escalate). Remember: three attempts, call early, and know when to cut.

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Rapid Sequence Intubation

Rapid Sequence Intubation (RSI) minimizes aspiration risk by inducing unconsciousness and paralysis nearly simultaneously, with no mask ventilation between. Mastering RSI requires disciplined adherence to the “7 Ps,” excellent pre-oxygenation, immediate confirmation with capnography, and a rehearsed plan for failed intubation.

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Fiberoptic Intubation

Fiberoptic intubation is the cornerstone of managing the anticipated difficult airway. By visualizing the glottis without aligning oral, pharyngeal, or laryngeal axes, it enables awake or anesthetized intubation. Mastery requires deliberate practice, topical anesthesia skills, and a clear backup plan.

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Supraglottic Airway Placement

Supraglottic Airway Placement

The supraglottic airway (SGA) sits above the glottis, providing rapid, hemodynamically stable ventilation for short, low‑risk cases. Master LMA and i‑gel insertion, cuff management, and troubleshooting leaks or obstruction. SGAs are critical rescue devices in “cannot intubate, cannot ventilate” scenarios. Never use with a full stomach.

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