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March 3, 2010

Reformulation of the Sedation Continuum

Author Affiliations

Author Affiliations: Department of Emergency Medicine, Loma Linda University Medical Center and Children's Hospital, Loma Linda, California (Dr Green); Department of Anesthesiology, Children's Hospital Boston, Boston, Massachusetts (Dr Mason); and Harvard Medical School, Boston (Dr Mason).

JAMA. 2010;303(9):876-877. doi:10.1001/jama.2010.217

A quarter century ago, the concept of sedation as a continuum represented by progressive stages was first introduced.1,2 These levels of sedation depth were defined by the patient's response to verbal or tactile (light or painful) stimulation. In 1985 this new sedation continuum nomenclature was revolutionary. Pulse oximetry had not yet been introduced, and physiological monitoring was limited to electrocardiogram and blood pressure. Without an objective way to assess ventilatory quality, the authors of the sedation continuum were forced to select subjective “responsiveness” as a surrogate marker to predict the risk of respiratory depression.1,2 With minor modification, their original definitions have been codified by the Joint Commission into the 4 progressive depths of minimal, moderate, and deep sedation followed by general anesthesia, levels between which patients can fluctuate.3

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